Healthcare Provider Details

I. General information

NPI: 1699576744
Provider Name (Legal Business Name): HOLLY FORAKER LPMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S DUPONT HWY STE 102
DOVER DE
19901-3778
US

IV. Provider business mailing address

222 S DUPONT HWY STE 102
DOVER DE
19901-3778
US

V. Phone/Fax

Practice location:
  • Phone: 302-313-1072
  • Fax: 302-883-8202
Mailing address:
  • Phone: 302-313-1072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0011564
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: