Healthcare Provider Details

I. General information

NPI: 1881744639
Provider Name (Legal Business Name): NICOLE ANN HOLONICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S ARCH ST SUITE 2A
CONNELLSVILLE PA
15425-3515
US

IV. Provider business mailing address

145 OGLEVEE LN
CONNELLSVILLE PA
15425-3841
US

V. Phone/Fax

Practice location:
  • Phone: 724-626-9941
  • Fax: 724-626-2785
Mailing address:
  • Phone: 724-626-9941
  • Fax: 724-626-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015395
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: