Provider Demographics
NPI:1205815362
Name:HARMON, HOLLY N (LISW-S)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:N
Last Name:HARMON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COLLEGE PARK
Mailing Address - Street 2:UNIVERSITY OF DAYTON
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-0910
Mailing Address - Country:US
Mailing Address - Phone:937-229-3141
Mailing Address - Fax:
Practice Address - Street 1:300 COLLEGE PARK
Practice Address - Street 2:UNIVERSITY OF DAYTON COUNSELING CENTER
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-0910
Practice Address - Country:US
Practice Address - Phone:937-229-3141
Practice Address - Fax:937-229-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144281041C0700X
OHI.20023691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI-2002369OtherOHIO SOCIAL WORK LICENSE