MEDICARE: MRS. HALBREONDA MCNEILL HOLLOWAY MSW, LCSW, LCAS

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	1041C0700X	Clinical Social Worker	P011540	NC

General Provider Information

NPI Number	:	1447789508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HALBREONDA MCNEILL HOLLOWAY MSW, LCSW, LCAS

Provider Business Mailing Address
First Line	:	701 SPENCER LN
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28081-0012
Country	:	US
Telephone Number	:	704-224-3077
Fax Number	:	704-694-4918

Provider Business Practice Location Address
First Line	:	705 S MAIN ST STE 7
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28081-4915
Country	:	US
Telephone Number	:	704-224-3077
Fax Number	:

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

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	07/19/2023

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