Active NPI
Russell C Holland, CAC
- Addiction (Substance Use Disorder) Counselor
- Martinsburg, WV
National Provider Identifier
1972746402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 08-106
- Practice address
- 99 Tavern Rd
Martinsburg, WV 25401-2890 - Phone
- (304) 263-7023
- Fax
- (304) 264-0508
- NPI assigned
- Apr 14, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 08-106 | WV | Primary |
Addresses
Primary practice location
99 Tavern Rd
Martinsburg, WV 25401-2890
Mailing address
PO Box 1067
Martinsburg, WV 25402-1067
Phone (304) 263-7023
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08-106 | WV | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319500800000",
"number": "1972746402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1067",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "254021067",
"telephone_number": "304-263-7023",
"fax_number": "304-264-0508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "99 TAVERN RD",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "254012890",
"telephone_number": "304-263-7023",
"fax_number": "304-264-0508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLAND",
"first_name": "RUSSELL",
"middle_name": "C",
"name_prefix": "Mr.",
"credential": "CAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-14",
"last_updated": "2011-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WV",
"license": "08-106",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martinsburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.