Provider Demographics
NPI:1578880001
Name:HOLLINGSWORTH, BRENDA JOY (LICSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOY
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 W GRANDRIDGE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1678
Mailing Address - Country:US
Mailing Address - Phone:509-539-3730
Mailing Address - Fax:833-471-3350
Practice Address - Street 1:8350 W GRANDRIDGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1678
Practice Address - Country:US
Practice Address - Phone:509-539-3730
Practice Address - Fax:833-471-3350
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW603439931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical