Provider Demographics
NPI:1104494202
Name:HOLLY STREET COUNSELING
Entity type:Organization
Organization Name:HOLLY STREET COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRESENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWOOD CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:717-805-4651
Mailing Address - Street 1:142 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-2735
Mailing Address - Country:US
Mailing Address - Phone:717-805-4651
Mailing Address - Fax:
Practice Address - Street 1:142 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-2735
Practice Address - Country:US
Practice Address - Phone:717-805-4651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty