Healthcare Provider Details

I. General information

NPI: 1912915794
Provider Name (Legal Business Name): LOIS B HOLLOWAY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 SHARPE HOSPITAL RD
WESTON WV
26452-8550
US

IV. Provider business mailing address

936 SHARPE HOSPITAL RD
WESTON WV
26452-8550
US

V. Phone/Fax

Practice location:
  • Phone: 304-269-1210
  • Fax: 304-269-0457
Mailing address:
  • Phone: 304-269-1210
  • Fax: 304-269-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number661
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: