Healthcare Provider Details

I. General information

NPI: 1821064759
Provider Name (Legal Business Name): HOLLY R. WARREN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 MAIN ST SUITE 203
HARRISBURG NC
28075-7427
US

IV. Provider business mailing address

6198 ROSEWAY CT
HARRISBURG NC
28075-6509
US

V. Phone/Fax

Practice location:
  • Phone: 704-400-5158
  • Fax: 704-455-7048
Mailing address:
  • Phone: 704-400-5158
  • Fax: 704-455-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004155
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: