Provider Demographics
NPI:1528601135
Name:COLCLASURE, HOLLY (LCSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:COLCLASURE
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 1:1605 CIRCLEDALE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6374
Mailing Address - Country:US
Mailing Address - Phone:501-680-5660
Mailing Address - Fax:
Practice Address - Street 1:305 S PALM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5432
Practice Address - Country:US
Practice Address - Phone:501-251-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-26
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3569-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical