Provider Demographics
NPI:1144810193
Name:WILSON, HOLLIE MICHELE (LCSW)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:MICHELE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HOLLIE
Other - Middle Name:MICHELE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3601 GALLOP CT
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3975
Mailing Address - Country:US
Mailing Address - Phone:205-238-1207
Mailing Address - Fax:
Practice Address - Street 1:2000 HIGHLAND VILLAGE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-8105
Practice Address - Country:US
Practice Address - Phone:205-238-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty