Healthcare Provider Details

I. General information

NPI: 1225227101
Provider Name (Legal Business Name): MELISSA DAWN HOLLOMAN LISW-CP & AP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN HOLLOMAN JORDAN LISW-CP & AP

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 N GROVE MEDICAL PARK DRIVE
SPARTANBURG SC
29303
US

IV. Provider business mailing address

279 N GROVE MEDICAL PARK DRIVE
SPARTANBURG SC
29303
US

V. Phone/Fax

Practice location:
  • Phone: 843-302-2211
  • Fax:
Mailing address:
  • Phone: 843-302-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4989
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4989
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4989
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4989
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4989
License Number StateSC
# 7
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4989
License Number StateSC
# 8
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4989
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: