Provider Demographics
NPI:1003912262
Name:YATES, HOLLY EVE
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:EVE
Last Name:YATES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:EVE
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4008 BARRETT DR
Mailing Address - Street 2:106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6621
Mailing Address - Country:US
Mailing Address - Phone:919-931-3270
Mailing Address - Fax:919-781-2660
Practice Address - Street 1:7633 MINE VALLEY RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6017
Practice Address - Country:US
Practice Address - Phone:919-931-3270
Practice Address - Fax:919-781-8660
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4745101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC140X6 BCBSNCOtherLPC
NC6102262Medicaid
NC359258 MHNOtherLPC