Provider Demographics
NPI:1417728361
Name:WHITE, HOLLY AMANDA (LPC)
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:AMANDA
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 RALPHS RDG APT 206
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-4407
Mailing Address - Country:US
Mailing Address - Phone:706-621-0313
Mailing Address - Fax:
Practice Address - Street 1:1915 AEROTECH DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-4222
Practice Address - Country:US
Practice Address - Phone:719-963-5695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0020075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional