Provider Demographics
NPI:1538554902
Name:WILLIAMS, HOLLY (LSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 138TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ENDERLIN
Mailing Address - State:ND
Mailing Address - Zip Code:58027-9537
Mailing Address - Country:US
Mailing Address - Phone:701-566-1773
Mailing Address - Fax:
Practice Address - Street 1:418 E BROADWAY AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4086
Practice Address - Country:US
Practice Address - Phone:701-224-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5098104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker