Individual
MR. RUSSELL C HOLLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAC
Contact information
Practice address
99 TAVERN RD, MARTINSBURG, WV 25401-2890
(304) 263-7023
(304) 264-0508
Mailing address
PO BOX 1067, MARTINSBURG, WV 25402-1067
(304) 263-7023
(304) 264-0508
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
08-106
WV
Other
Enumeration date
04/14/2009
Last updated
10/25/2011
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