Provider Demographics
NPI:1760177372
Name:WADSWORTH, HOLLY C (CDCA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:C
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2407
Mailing Address - Country:US
Mailing Address - Phone:419-334-4644
Mailing Address - Fax:
Practice Address - Street 1:206 N CLOVER ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2407
Practice Address - Country:US
Practice Address - Phone:419-334-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.184059101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)