Healthcare Provider Details

I. General information

NPI: 1407040728
Provider Name (Legal Business Name): DELORES GREGORY HOLLEN MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8799 OLD HIGHWAY #6
SANTEE SC
29142
US

IV. Provider business mailing address

1039 PLANTERS PLACE
MT PLEASANT SC
29464
US

V. Phone/Fax

Practice location:
  • Phone: 843-303-2779
  • Fax:
Mailing address:
  • Phone: 843-303-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4338
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: