Provider Demographics
NPI:1780015131
Name:HOLLY, SARA (BS, SAC-IT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HOLLY
Suffix:
Gender:F
Credentials:BS, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 E HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1528
Mailing Address - Country:US
Mailing Address - Phone:414-331-5824
Mailing Address - Fax:
Practice Address - Street 1:135 W WELLS ST
Practice Address - Street 2:SUITE 700
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1830
Practice Address - Country:US
Practice Address - Phone:414-347-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16998-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)