Provider Demographics
NPI:1033395868
Name:HOLLINGSWORTH, MICHAEL BENJAMIN (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BENJAMIN
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 562563
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28256-2563
Mailing Address - Country:US
Mailing Address - Phone:704-926-5030
Mailing Address - Fax:704-927-0482
Practice Address - Street 1:3500 ELLINGTON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1102
Practice Address - Country:US
Practice Address - Phone:704-926-5030
Practice Address - Fax:704-927-0482
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6810101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional