Provider Demographics
NPI:1134677248
Name:HOLLEY, LYNNE CHANTEL (LCSW, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:CHANTEL
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:MS
Other - First Name:LYNNE
Other - Middle Name:CHANTEL
Other - Last Name:MALLORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-0358
Mailing Address - Country:US
Mailing Address - Phone:770-568-0619
Mailing Address - Fax:973-629-1741
Practice Address - Street 1:50 UNION AVE STE 804B
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-5221
Practice Address - Country:US
Practice Address - Phone:770-568-0619
Practice Address - Fax:973-629-1741
Is Sole Proprietor?:No
Enumeration Date:2016-09-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00259900101YA0400X
NJ44SC057179001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)