Provider Demographics
NPI:1538503701
Name:HERRICK, HOLLY (BS, AAC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HERRICK
Suffix:
Gender:F
Credentials:BS, AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 9TH AVE # MS 359797
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2420
Mailing Address - Country:US
Mailing Address - Phone:062-744-9600
Mailing Address - Fax:062-744-9854
Practice Address - Street 1:325 9TH AVE # MS 359797
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-744-9672
Practice Address - Fax:206-744-9854
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60268956101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor