Provider Demographics
NPI:1619213592
Name:HOLLINGER, GWEN WILSON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:WILSON
Last Name:HOLLINGER
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 1:113 CHAPLIN DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-2101
Mailing Address - Country:US
Mailing Address - Phone:337-521-7093
Mailing Address - Fax:
Practice Address - Street 1:301 DUNAND ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2215
Practice Address - Country:US
Practice Address - Phone:337-521-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA74361041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool