Healthcare Provider Details

I. General information

NPI: 1972660397
Provider Name (Legal Business Name): CAROLYN S HOLLAND M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 HEMLOCK TRL
CROWNSVILLE MD
21032-1723
US

IV. Provider business mailing address

384 HEMLOCK TRL
CROWNSVILLE MD
21032-1723
US

V. Phone/Fax

Practice location:
  • Phone: 410-923-3765
  • Fax:
Mailing address:
  • Phone: 410-923-3765
  • Fax: 410-923-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number08499
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: