Provider Demographics
NPI:1356677405
Name:WILLIAMS, HOLLY SUSAN (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:SUSAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 COURT ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3638
Mailing Address - Country:US
Mailing Address - Phone:503-871-9680
Mailing Address - Fax:
Practice Address - Street 1:456 COURT ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3638
Practice Address - Country:US
Practice Address - Phone:503-871-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-25
Last Update Date:2009-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional