Provider Demographics
NPI:1699024851
Name:HOLLIS, LIA MARIE (LMSW, LCDC-I)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:MARIE
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:LMSW, LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 BRAESVIEW
Mailing Address - Street 2:#203
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4845
Mailing Address - Country:US
Mailing Address - Phone:248-924-7999
Mailing Address - Fax:
Practice Address - Street 1:9100 W IH 10
Practice Address - Street 2:STE 205
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3113
Practice Address - Country:US
Practice Address - Phone:248-924-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010943151041C0700X
TX606811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical