Healthcare Provider Details

I. General information

NPI: 1740006584
Provider Name (Legal Business Name): ADRIANA GUADALUPE HOLLIFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MAUNEY AVE
OLD FORT NC
28762-6723
US

IV. Provider business mailing address

176 MILLER AVE
MARION NC
28752-4088
US

V. Phone/Fax

Practice location:
  • Phone: 828-668-7646
  • Fax:
Mailing address:
  • Phone: 828-317-7643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: