Provider Demographics
NPI:1750520052
Name:DESANTIS, HOLLY BARBARA (LPCC)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:BARBARA
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 HOSBROOK RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2901
Mailing Address - Country:US
Mailing Address - Phone:513-861-9797
Mailing Address - Fax:
Practice Address - Street 1:8040 HOSBROOK RD
Practice Address - Street 2:SUITE 320
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2901
Practice Address - Country:US
Practice Address - Phone:513-861-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0002388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311326678OtherTAX ID NUMBER