Provider Demographics
NPI:1366835589
Name:DR MARCIA HOLLINGSWORTH, ED.D, PLLC
Entity Type:Organization
Organization Name:DR MARCIA HOLLINGSWORTH, ED.D, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:616-450-5535
Mailing Address - Street 1:2025 E BELTLINE AVE SE STE 102
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7673
Mailing Address - Country:US
Mailing Address - Phone:616-450-5535
Mailing Address - Fax:616-957-1438
Practice Address - Street 1:2025 E BELTLINE AVE SE STE 102
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7673
Practice Address - Country:US
Practice Address - Phone:616-450-5535
Practice Address - Fax:616-957-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007516103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty