Healthcare Provider Details

I. General information

NPI: 1821901448
Provider Name (Legal Business Name): HOLLYLEAF HEALING LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WARWICK AVE
SOUTH PASADENA CA
91030-3519
US

IV. Provider business mailing address

1107 FAIR OAKS AVE # 284
SOUTH PASADENA CA
91030-3311
US

V. Phone/Fax

Practice location:
  • Phone: 626-563-8958
  • Fax:
Mailing address:
  • Phone: 626-563-8958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARGARET ROSS
Title or Position: FOUNDER
Credential: LCSW
Phone: 626-563-8958