Provider Demographics
NPI:1619059664
Name:HOLLINGSWORTH, DENNIS J (MA)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 581267
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0022
Mailing Address - Country:US
Mailing Address - Phone:530-919-2177
Mailing Address - Fax:916-647-0147
Practice Address - Street 1:3750 AUBURN BLVD STE D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2134
Practice Address - Country:US
Practice Address - Phone:530-919-2177
Practice Address - Fax:916-647-0147
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT95751106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204593OtherLMFT LICENSE