Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PS002908L | PA |
N | 103T00000X | Psychologist | PS002908L | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS002908L | PA |
N | 103G00000X | Clinical Psychologist | PS002908L | PA |
N | 103TC0700X | Clinical Psychologist | PS002908L | PA |
N | 103TP2701X | Group Psychotherapist | PS002908L | PA |
NPI | 1548376049 |
---|---|
Provider Name | Dr. Anita V. Hole |
First Address | Ardmore, PA 19003-2508 |
Second Address | Philadelphia, PA 19102-2944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |