Provider Demographics
NPI:1811480320
Name:DE SAMBOURG, HOLLY J (LCSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
Last Name:DE SAMBOURG
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RHONDA ANN PL
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71909-9645
Mailing Address - Country:US
Mailing Address - Phone:501-500-4091
Mailing Address - Fax:501-307-1475
Practice Address - Street 1:101 RHONDA ANN PL
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71909-9645
Practice Address - Country:US
Practice Address - Phone:501-500-4091
Practice Address - Fax:501-307-1475
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8308-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical