Doctor Name: | RUTH ANN HOLLIS |
NPI Number: | 1629337399 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 6336 |
Business Practice Address: | 9420 Blackshear Hwy Baxley, GA - 315135715 |
Business Phone Number: | 9123676691 |
Business Fax Number: | 9123672268 |
Mailing Address: | 4705 Oscar Tippins Rd, BAXLEY |
State: | GA |
Postal Code: | 315136658 |
Phone Number: | 9123679500 |
Fax Number: | 9123672268 |
NPI Enumeration Date: | 05/15/2012 |
NPI Last Update Date: | 05/15/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 6336 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |