Provider Demographics
NPI:1962213884
Name:SHOLLY, JANUARY ELAINE (LSW)
Entity type:Individual
Prefix:
First Name:JANUARY
Middle Name:ELAINE
Last Name:SHOLLY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 AMBER ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3714
Mailing Address - Country:US
Mailing Address - Phone:570-238-4847
Mailing Address - Fax:
Practice Address - Street 1:135 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5447
Practice Address - Country:US
Practice Address - Phone:412-999-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW142331104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker