MEDICARE: MRS. RACHAEL SHINGLER HOLLOMAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC005899	GA

General Provider Information

NPI Number	:	1366760696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHAEL SHINGLER HOLLOMAN LPC

Provider Business Mailing Address
First Line	:	1803 CANTERBURY DR STE C
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-0505
Country	:	US
Telephone Number	:	229-247-4237
Fax Number	:	229-247-4239

Provider Business Practice Location Address
First Line	:	1803 CANTERBURY DR STE C
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-0505
Country	:	US
Telephone Number	:	229-247-4237
Fax Number	:	229-247-4239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2010
Last Update Date	:	05/11/2010

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