Provider Demographics
NPI:1801992821
Name:HOLLAND, CLAY III (LCSW, QCSW)
Entity type:Individual
Prefix:MR
First Name:CLAY
Middle Name:
Last Name:HOLLAND
Suffix:III
Gender:M
Credentials:LCSW, QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 LEHIGH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3853
Mailing Address - Country:US
Mailing Address - Phone:610-504-2199
Mailing Address - Fax:610-330-9981
Practice Address - Street 1:2030 LEHIGH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3853
Practice Address - Country:US
Practice Address - Phone:610-504-2199
Practice Address - Fax:610-330-9981
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0138001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA089915Medicare ID - Type Unspecified