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General NPI Number Information
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NPI Number | 1821025453
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Entity Type | Individual
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Provider Name | KEVIN MICHAEL HOLLOWAY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 2053 COHASSET CT
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City | FREDERICK
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State | MD
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Zip | 21702-9502
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Country | US
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Telephone | 240-285-9879
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 W 7TH ST UNIT 1309
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City | FREDERICK
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State | MD
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Zip | 21702-7514
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Country | US
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Telephone | 240-285-9879
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60061186
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 06382
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License Number State | MD
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