Healthcare Provider Details

I. General information

NPI: 1689207664
Provider Name (Legal Business Name): CHARITY HOLLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W MAIN ST STE 100
ABINGDON VA
24210-2608
US

IV. Provider business mailing address

PO BOX 291943
NASHVILLE TN
37229-1943
US

V. Phone/Fax

Practice location:
  • Phone: 833-952-0829
  • Fax:
Mailing address:
  • Phone: 833-953-0829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: