Provider Demographics
NPI:1770378937
Name:HOLLY, JERRICA (LICSW)
Entity type:Individual
Prefix:
First Name:JERRICA
Middle Name:
Last Name:HOLLY
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:JERRICA
Other - Middle Name:
Other - Last Name:HOLLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:6715 NE 63RD ST STE 267
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-1980
Mailing Address - Country:US
Mailing Address - Phone:816-518-9490
Mailing Address - Fax:
Practice Address - Street 1:6715 NE 63RD ST STE 267
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-1980
Practice Address - Country:US
Practice Address - Phone:816-518-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610861801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical