MEDICARE: DAVONDA MICHELLE HOLLOWAY MSW,LCSW-A

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	1041C0700X	Clinical Social Worker	P015160	NC

General Provider Information

NPI Number	:	1922680164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVONDA MICHELLE HOLLOWAY MSW,LCSW-A

Provider Business Mailing Address
First Line	:	319 S WESTGATE DR STE D
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1632
Country	:	US
Telephone Number	:	434-429-7892
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 S WESTGATE DR STE D
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1632
Country	:	US
Telephone Number	:	866-700-1606
Fax Number	:	866-338-5921

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

Provider Enumeration Date	:	04/27/2021
Last Update Date	:	08/01/2023

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