Provider Demographics
NPI:1942645080
Name:ROSE, HOLLY E (LCSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:E
Last Name:ROSE
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 1:23414 SEVEN WINDS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7136
Mailing Address - Country:US
Mailing Address - Phone:210-878-5703
Mailing Address - Fax:
Practice Address - Street 1:23414 SEVEN WINDS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7136
Practice Address - Country:US
Practice Address - Phone:210-878-5703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX405391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical