Basic Information
| Provider Information | |||||||||
| NPI: | 1003565771 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOLLY RIOUX LICSW PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 HANOVER ST STE 200 | ||||||||
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| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031012230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178040948 | ||||||||
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| Practice Location | |||||||||
| Address1: | 66 HANOVER ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031012230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178040948 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2022 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | RIOUX | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6178040948 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.