Provider Demographics
NPI:1861789190
Name:WILLARD, HOLLY RAE (BS,CCS,CADC)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:RAE
Last Name:WILLARD
Suffix:
Gender:F
Credentials:BS,CCS,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S IZARD ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-3810
Mailing Address - Country:US
Mailing Address - Phone:870-630-1990
Mailing Address - Fax:870-633-2624
Practice Address - Street 1:112 S IZARD ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-3810
Practice Address - Country:US
Practice Address - Phone:870-630-1990
Practice Address - Fax:870-633-2624
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1357101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)