Provider Demographics
NPI:1346770542
Name:HEMMINGER, HOLLY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:HEMMINGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:RAINES-BAXTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1004 W YUCCA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3335
Mailing Address - Country:US
Mailing Address - Phone:575-520-1660
Mailing Address - Fax:
Practice Address - Street 1:224 W D. L. INGRAM AVE BLDG. 1408
Practice Address - Street 2:
Practice Address - City:CANON AIR FORCE BASE
Practice Address - State:NM
Practice Address - Zip Code:87103
Practice Address - Country:US
Practice Address - Phone:575-637-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NMC-110121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty