Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 4989 | SC |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 4989 | SC |
N | 101YM0800X | Mental Health Counselor | 4989 | SC |
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | 4989 | SC |
N | 104100000X | Social Worker | 4989 | SC |
Y | 1041C0700X | Clinical Social Worker | 4989 | SC |
NPI | 1225227101 |
---|---|
Provider Name | Melissa Dawn Holloman |
First Address | Spartanburg, SC 29303 |
Second Address | Spartanburg, SC 29303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2007 |
Last Update Date | 11/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q322560281 | MEDICARE (01) | SC |