Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 105135 | TX |
NPI | 1003485897 |
---|---|
Provider Name | Darryl Ernest Holland |
First Address | Fort Campbell, KY 42223-5318 |
Second Address | Fort Campbell, KY 42223-5318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2021 |
Last Update Date | 24/06/2021 |