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General NPI Number Information
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NPI Number | 1790393973
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Entity Type | Individual
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Provider Name | KELLEY HOLLADAY PHD, LMHC, LPCC, MAC
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Gender | Female
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 712 S OCEAN SHORE BLVD STE 218
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-3602
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Country | US
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Telephone | 904-894-1754
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Fax |
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Provider Business Mailing Address
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Address Line | 712 S OCEAN SHORE BLVD STE 218
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-3602
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Country | US
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Telephone | 904-894-1754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12648
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License Number State | FL
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