Provider Demographics
NPI:1962083220
Name:FUNGER, HOLLY (LCSW-C)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:FUNGER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 PROSPECT BAY DR W
Mailing Address - Street 2:
Mailing Address - City:GRASONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21638-1186
Mailing Address - Country:US
Mailing Address - Phone:301-509-7684
Mailing Address - Fax:
Practice Address - Street 1:263 PROSPECT BAY DR W
Practice Address - Street 2:
Practice Address - City:GRASONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21638-1186
Practice Address - Country:US
Practice Address - Phone:301-509-7684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16163101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health