=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790205839
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER S HOLOP LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2017
-----------------------------------------------------
Last Update Date | 10/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10485 HELEY ST
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34608-3729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-456-9919
-----------------------------------------------------
Fax | 352-681-4438
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10485 HELEY ST
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34608-3729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-456-9919
-----------------------------------------------------
Fax | 352-681-4438
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 16502
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------