Healthcare Provider Details

I. General information

NPI: 1063136422
Provider Name (Legal Business Name): HOLLY DEVIVO LMSW-C, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 S HILLS DR
BATTLE CREEK MI
49015-3954
US

IV. Provider business mailing address

396 S HILLS DR
BATTLE CREEK MI
49015-3954
US

V. Phone/Fax

Practice location:
  • Phone: 616-516-5360
  • Fax:
Mailing address:
  • Phone: 616-516-5360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6851114547
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: