Individual
NATHANIEL HOLLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9424 NELSON AVE, CLEVELAND, OH 44105-4059
(216) 562-9767
Mailing address
1400 E 55TH ST, CLEVELAND, OH 44103-1304
(216) 848-5428
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
175T00000X
Peer Specialist
Primary
01519
OH
Other
Enumeration date
01/15/2020
Last updated
12/08/2020
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