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Organization
S'D'K SHOP
Active
Organization
S'D'K SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATONYA HOLLAND (OWNER)
(737) 326-5315
Entity
Organization
Contact information
Practice address
12621 HYMEADOW DR RM 331, AUSTIN, TX 78729-2700
(737) 326-5315
Mailing address
12621 HYMEADOW DR RM 331, AUSTIN, TX 78729-2700
(737) 326-5315
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/16/2024
Last updated
05/16/2024
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