Healthcare Provider Details

I. General information

NPI: 1780015131
Provider Name (Legal Business Name): SARA HOLLY LPC, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 N 39TH ST
MILWAUKEE WI
53208-3746
US

IV. Provider business mailing address

925 E HAMILTON ST
MILWAUKEE WI
53202-1528
US

V. Phone/Fax

Practice location:
  • Phone: 414-962-1200
  • Fax:
Mailing address:
  • Phone: 414-331-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16036-132
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6436-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: