MEDICARE: MR. ELLIS CRAIG HOLLOWAY JR. QBA,LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	3877	NC

General Provider Information

NPI Number	:	1427909159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ELLIS CRAIG HOLLOWAY JR. QBA,LBA

Provider Business Mailing Address
First Line	:	5109 SANSOME TRL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-6451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 N TRYON ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-0202
Country	:	US
Telephone Number	:	984-363-2678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/12/2026

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Directions to “ MR. ELLIS CRAIG HOLLOWAY JR. QBA,LBA” Practice Location

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