Provider Demographics
NPI:1821064759
Name:WARREN, HOLLY R (LCSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:R
Last Name:WARREN
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 1:6198 ROSEWAY CT
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-6509
Mailing Address - Country:US
Mailing Address - Phone:704-400-5158
Mailing Address - Fax:704-455-7048
Practice Address - Street 1:4351 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7427
Practice Address - Country:US
Practice Address - Phone:704-400-5158
Practice Address - Fax:704-455-7048
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003216Medicaid
NC2879185Medicare ID - Type Unspecified