Provider Demographics
NPI:1003247552
Name:HOLLIDAY, BRYAN (LCSWA, CSAC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:HOLLIDAY
Suffix:
Gender:M
Credentials:LCSWA, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 STERLING ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2355
Mailing Address - Country:US
Mailing Address - Phone:910-551-8552
Mailing Address - Fax:
Practice Address - Street 1:4602 STERLING ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2355
Practice Address - Country:US
Practice Address - Phone:910-551-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0084801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical