Provider Information for 1063798015
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Ms. HOLLY R DEGRAND LPC
Sex: Female
NPI: 1063798015
Last Updated: 2015-03-23
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1063798015 | ||||||||
| Enumeration Date | 2011-10-21 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2340 BEAVER RUIN RD APT 74 NORCROSS, GA 30071-3220 United States Phone: 678-492-6822 | Fax: | ||||||||
| Primary Practice Address | 950 SCALES RD SUITE 302 SUWANEE, GA 30024-4340 United States Phone: 404-994-5000 | Fax:888-264-8367 | ||||||||
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