Provider Demographics
NPI:1922628288
Name:NICOLE HOLLINSWORTH
Entity Type:Organization
Organization Name:NICOLE HOLLINSWORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:206-429-4162
Mailing Address - Street 1:7707 GREENWOOD AVE N APT 302
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4655
Mailing Address - Country:US
Mailing Address - Phone:206-429-4162
Mailing Address - Fax:
Practice Address - Street 1:7707 GREENWOOD AVE N APT 302
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4655
Practice Address - Country:US
Practice Address - Phone:206-429-4162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)