Healthcare Provider Details

I. General information

NPI: 1427169424
Provider Name (Legal Business Name): HOLLINGSWORTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9631 MORROW AVE NE
ALBUQUERQUE NM
87112-2951
US

IV. Provider business mailing address

9631 MORROW AVE NE
ALBUQUERQUE NM
87112-2951
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-2584
  • Fax: 505-275-3810
Mailing address:
  • Phone: 505-275-2584
  • Fax: 505-275-3810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAN K HOLLINGSWORTH
Title or Position: PRESIDENT
Credential: MA, LPCC
Phone: 505-275-2584