Healthcare Provider Details

I. General information

NPI: 1669308748
Provider Name (Legal Business Name): STACEY TARASE HOLLEY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 JULIET LN
NOTTINGHAM MD
21236-1233
US

IV. Provider business mailing address

20 JULIET LN
NOTTINGHAM MD
21236-1233
US

V. Phone/Fax

Practice location:
  • Phone: 410-382-0379
  • Fax:
Mailing address:
  • Phone: 410-382-0379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28982
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: