Healthcare Provider Details

I. General information

NPI: 1992620611
Provider Name (Legal Business Name): HOLLY ELIZABETH INGOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 SUWANEE DAM RD STE 720
SUWANEE GA
30024-8708
US

IV. Provider business mailing address

1229 WOODMERE DR
LOGANVILLE GA
30052-8638
US

V. Phone/Fax

Practice location:
  • Phone: 678-993-8494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: