Provider Demographics
NPI:1679796189
Name:HOLLEY, ANDREA DAWN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DAWN
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MR
Other - First Name:ANDREA
Other - Middle Name:DAWN
Other - Last Name:ROLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, BHRS
Mailing Address - Street 1:2402 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-8507
Mailing Address - Country:US
Mailing Address - Phone:580-372-0933
Mailing Address - Fax:
Practice Address - Street 1:2402 TANGLEWOOD LN
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-8507
Practice Address - Country:US
Practice Address - Phone:580-372-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
OK4060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical