Individual
HOLLY JUSTINE LASTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LICSW
Contact information
Practice address
7895 EAST RIVER ROAD, APT 201, FRIDLEY, MN 55432
(707) 496-0167
Mailing address
7895 EAST RIVER ROAD, APT 201, FRIDLEY, MN 55432
(707) 496-0167
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
7975
OR
1041C0700X
Clinical Social Worker
Primary
LCSW7975
OR
Other
Enumeration date
05/14/2020
Last updated
06/27/2023
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