Basic Information
Provider Information | |||||||||
NPI: | 1548692791 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOLLINGSWORTH | ||||||||
FirstName: | SHAR | ||||||||
MiddleName: | GILBERT | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1745 | ||||||||
Address2: |   | ||||||||
City: | CUMBERLAND | ||||||||
State: | MD | ||||||||
PostalCode: | 215011745 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3017595050 | ||||||||
FaxNumber: | 3017772098 | ||||||||
Practice Location | |||||||||
Address1: | 12503 WILLOWBROOK RD | ||||||||
Address2: |   | ||||||||
City: | CUMBERLAND | ||||||||
State: | MD | ||||||||
PostalCode: | 215022554 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3017595050 | ||||||||
FaxNumber: | 3017772098 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/30/2013 | ||||||||
LastUpdateDate: | 12/16/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LC5902 | MD | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.