Individual provider Active NPI

Holly R. Warren, LCSW

  • Clinical Social Worker
  • Harrisburg, NC
National Provider Identifier
1821064759
Registry record updated Mar 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C004155 Issued in NC
Practice address
4351 Main St
Suite 203
Harrisburg, NC 28075-7427
Phone
(704) 400-5158
Fax
(704) 455-7048
NPI assigned
Feb 28, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C004155 NC Primary

Addresses

Primary practice location

4351 Main St
Suite 203
Harrisburg, NC 28075-7427

Mailing address

6198 Roseway CT
Harrisburg, NC 28075-6509
Phone (704) 400-5158

Other identifiers 1

IdentifierTypeStateIssuer
6003216MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C004155NCMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268265600000",
    "number": "1821064759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6198 ROSEWAY CT",
            "city": "HARRISBURG",
            "state": "NC",
            "postal_code": "280756509",
            "telephone_number": "704-400-5158",
            "fax_number": "704-455-7048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4351 MAIN ST",
            "address_2": "SUITE 203",
            "city": "HARRISBURG",
            "state": "NC",
            "postal_code": "280757427",
            "telephone_number": "704-400-5158",
            "fax_number": "704-455-7048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "HOLLY",
        "middle_name": "R.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-28",
        "last_updated": "2010-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C004155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6003216",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisburg, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.