Individual
HOLLY BLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, NCC
Contact information
Practice address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 672-2691
Mailing address
548 SE JACKSON ST, ROSEBURG, OR 97470-4983
(541) 672-2691
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
R6746
OR
Other
Enumeration date
05/13/2019
Last updated
08/03/2022
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