Healthcare Provider Details

I. General information

NPI: 1205815362
Provider Name (Legal Business Name): HOLLY N HARMON LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 07/18/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLLEGE PARK UNIVERSITY OF DAYTON COUNSELING CENTER
DAYTON OH
45459-0910
US

IV. Provider business mailing address

300 COLLEGE PARK UNIVERSITY OF DAYTON
DAYTON OH
45459-0910
US

V. Phone/Fax

Practice location:
  • Phone: 937-229-3141
  • Fax: 937-229-2226
Mailing address:
  • Phone: 937-229-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014428
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2002369
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: