Provider Demographics
NPI:1538781356
Name:HOULDSWORTH, VIRGINIA LILLIAN (LCSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LILLIAN
Last Name:HOULDSWORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7913
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88355
Mailing Address - Country:US
Mailing Address - Phone:281-468-6875
Mailing Address - Fax:
Practice Address - Street 1:2904 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6338
Practice Address - Country:US
Practice Address - Phone:281-468-6875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-086911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical