Healthcare Provider Details

I. General information

NPI: 1649593401
Provider Name (Legal Business Name): KATHERINE ANN HOLLEY LMSW, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7024 CENTRAL AVE STE 107
ST PETERSBURG FL
33707-1263
US

IV. Provider business mailing address

7024 CENTRAL AVE STE 107
ST PETERSBURG FL
33707-1263
US

V. Phone/Fax

Practice location:
  • Phone: 714-794-2885
  • Fax:
Mailing address:
  • Phone: 714-794-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094477
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW106619
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-03057
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRALR9570919
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: