Individual
MRS. HOLLY R LICHTSINN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
10319 DAWSONS CREEK BLVD, SUITE H, FORT WAYNE, IN 46825-1911
(260) 969-5583
(260) 969-5584
Mailing address
10319 DAWSONS CREEK BLVD, SUITE H, FORT WAYNE, IN 46825-1911
(260) 969-5583
(260) 969-5584
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100124250
—
IN
Enumeration date
01/23/2007
Last updated
02/25/2010
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