Healthcare Provider Details

I. General information

NPI: 1801361050
Provider Name (Legal Business Name): KIMBERLY HOLLOWAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 OCONEE SQUARE DR
SENECA SC
29678-2546
US

IV. Provider business mailing address

55 BEATTIE PL STE 810
GREENVILLE SC
29601-2191
US

V. Phone/Fax

Practice location:
  • Phone: 800-805-6889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number9813
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: