Doctor Name: | MR. WILLIAM K HOLLEY |
NPI Number: | 1346548450 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 219809 |
Business Practice Address: | 2732 Holly Berry Dr Ellenwood, GA - 30294 |
Business Phone Number: | 4043627904 |
Business Fax Number: | |
Mailing Address: | 2732 Holly Berry Dr, ELLENWOOD |
State: | GA |
Postal Code: | 30294 |
Phone Number: | 4043627904 |
Fax Number: | |
NPI Enumeration Date: | 03/14/2011 |
NPI Last Update Date: | 03/14/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YS0200X |
License Number: | 219809 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | School |
Taxonomy Definition: |