Provider Demographics
NPI:1073289492
Name:HARDWICK, HOLLY L (LPC)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:L
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1802
Mailing Address - Country:US
Mailing Address - Phone:314-422-3359
Mailing Address - Fax:
Practice Address - Street 1:4516 WESTMINSTER PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1802
Practice Address - Country:US
Practice Address - Phone:314-422-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021030369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty