Provider Demographics
NPI:1225353212
Name:HOLLINGSHEAD, JEANNE C (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:C
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 1:85 SANGERS LN
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-6712
Mailing Address - Country:US
Mailing Address - Phone:540-887-3200
Mailing Address - Fax:540-887-3240
Practice Address - Street 1:4901 DICKENS RD STE 115
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1952
Practice Address - Country:US
Practice Address - Phone:312-391-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040073441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1649205212Medicaid