Provider Demographics
NPI:1144865908
Name:HOLLY JOHNSON CARR, LCSW, PLLC
Entity type:Organization
Organization Name:HOLLY JOHNSON CARR, LCSW, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-623-4148
Mailing Address - Street 1:1801 W CORNELIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1019
Mailing Address - Country:US
Mailing Address - Phone:773-755-2271
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST STE 910
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1717
Practice Address - Country:US
Practice Address - Phone:312-702-1077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty