Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | P008480 | NC |
NPI | 1003247552 |
---|---|
Provider Name | Bryan Holliday |
First Address | Fayetteville, NC 28306-2355 |
Second Address | Fayetteville, NC 28306-2355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2013 |
Last Update Date | 10/12/2013 |