Healthcare Provider Details

I. General information

NPI: 1609176874
Provider Name (Legal Business Name): CAMERON SCOTT HOLLENBERG LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 SHERMAN AVE
FREDERICK MD
21701-6321
US

IV. Provider business mailing address

2851 S KING DR APT 1602
CHICAGO IL
60616-2950
US

V. Phone/Fax

Practice location:
  • Phone: 240-422-8824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC6582
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: