Provider Demographics
NPI:1114964459
Name:HOLLINGSHEAD, CAROLYN (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:HOLLINGSHEAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 N EAGLE CV
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6691
Mailing Address - Country:US
Mailing Address - Phone:801-557-7565
Mailing Address - Fax:
Practice Address - Street 1:2480 RED CLIFFS DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5457
Practice Address - Country:US
Practice Address - Phone:435-673-6446
Practice Address - Fax:435-673-6446
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT029486335011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
005732312Medicare ID - Type Unspecified
Q49537Medicare UPIN