Healthcare Provider Details

I. General information

NPI: 1225176597
Provider Name (Legal Business Name): TALITHA TAYLOR HOLLIFIELD LPC LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3169 2ND AVE E
BIG STONE GAP VA
24219-3805
US

IV. Provider business mailing address

1167 SPRATLIN PARK DR
GRAY TN
37615-6205
US

V. Phone/Fax

Practice location:
  • Phone: 276-523-8300
  • Fax: 423-467-3644
Mailing address:
  • Phone: 423-467-3600
  • Fax: 423-467-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002203
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000341LMFT
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: