Provider Demographics
NPI:1851179576
Name:MOTLEY, HOLLY J (LCSW-A)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 OLIVERS CROSSING CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-7164
Mailing Address - Country:US
Mailing Address - Phone:336-582-1280
Mailing Address - Fax:
Practice Address - Street 1:2121 EASTCHESTER DR STE 105
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1535
Practice Address - Country:US
Practice Address - Phone:336-332-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0169231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty