Basic Information
| Provider Information | |||||||||
| NPI: | 1477659845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLANDSWORTH | ||||||||
| FirstName: | PHYLLIS | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9671 | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321209671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866767100 | ||||||||
| FaxNumber: | 3866767125 | ||||||||
| Practice Location | |||||||||
| Address1: | 1340 RIDGEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | HOLLY HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321172320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866767100 | ||||||||
| FaxNumber: | 3866767125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MT1581 | FL | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.