Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Holly Justine Lastine, LCSW, LICSW

Individual provider Clinical Social Worker · NPI 1720600547

Holly Justine Lastine, LCSW, LICSW is a Clinical Social Worker in Fridley, Minnesota. Practices as a sole proprietor. Licensed in Oregon.

Licensed in
OR
In the registry since
2020
Specialties on file
2
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

7895 E River Rd Apt 201
Fridley, MN 55432
Phone: (707) 496-0167
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LCSW7975 (OR)
Clinical Social Worker Taxonomy 1041C0700X · Licence 7975 (OR)

Record details

NPI number1720600547
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW , LICSW
Sole proprietorYes
NPI enumeratedMay 14, 2020
Last updated in NPPESJune 27, 2023
Certification dateJune 27, 2023

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