Provider Demographics
NPI:1609612357
Name:HOLLINS, ERVIN JR
Entity type:Individual
Prefix:
First Name:ERVIN
Middle Name:
Last Name:HOLLINS
Suffix:JR
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 SEWARD ST APT 303
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2350
Mailing Address - Country:US
Mailing Address - Phone:313-808-9614
Mailing Address - Fax:
Practice Address - Street 1:1190 SEWARD ST APT 303
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2350
Practice Address - Country:US
Practice Address - Phone:313-808-9614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker