Healthcare Provider Details

I. General information

NPI: 1902717580
Provider Name (Legal Business Name): MRS. RESHONDA HOLLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 MAIN STREET
WINTERVILLE NC
28590
US

IV. Provider business mailing address

PO BOX 503
WINTERVILLE NC
28590-0503
US

V. Phone/Fax

Practice location:
  • Phone: 252-862-5180
  • Fax:
Mailing address:
  • Phone: 252-862-5180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP027584
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: