Provider Demographics
NPI:1457049611
Name:HARRIS, HOLLY E (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 COOLIDGE DR
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-3768
Mailing Address - Country:US
Mailing Address - Phone:304-671-8006
Mailing Address - Fax:
Practice Address - Street 1:179 E BURR BLVD STE L
Practice Address - Street 2:
Practice Address - City:KEARNEYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25430-4964
Practice Address - Country:US
Practice Address - Phone:304-268-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00945554104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker