Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1326680794 |
---|---|
Provider Name | Dorothy Lynn Holidy |
First Address | Modesto, CA 95351-1596 |
Second Address | Modesto, CA 95350-5905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2019 |
Last Update Date | 17/10/2019 |