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General NPI Number Information
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NPI Number | 1942978044
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Entity Type | Individual
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Provider Name | SUSAN HOLLOWELL WILLSMORE LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 2677 N MAIN ST STE 130
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City | SANTA ANA
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State | CA
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Zip | 92705-6665
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Country | US
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Telephone | 714-551-7077
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Fax |
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Provider Business Mailing Address
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Address Line | 3466 DATA DR APT 1234
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-7964
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Country | US
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Telephone | 302-399-3021
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW102534
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License Number State | CA
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