Healthcare Provider Details

I. General information

NPI: 1558199018
Provider Name (Legal Business Name): HOLLY DENISE HUFFMAN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 NILLES RD STE 5
FAIRFIELD OH
45014-7205
US

IV. Provider business mailing address

4010 EXECUTIVE PK DR STE 225
CINCINNATI OH
45241-4010
US

V. Phone/Fax

Practice location:
  • Phone: 513-939-0300
  • Fax:
Mailing address:
  • Phone: 937-397-1693
  • Fax: 518-898-3681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2005066
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: