Provider Demographics
NPI:1952573354
Name:HOUSEN, HOLLY G (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:G
Last Name:HOUSEN
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10632 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 311
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3273
Mailing Address - Country:US
Mailing Address - Phone:410-730-6950
Mailing Address - Fax:410-740-0909
Practice Address - Street 1:10632 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 311
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3273
Practice Address - Country:US
Practice Address - Phone:410-730-6950
Practice Address - Fax:410-730-1411
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW509 KEO7COOtherCAREFIRST BLUECROSS