Provider Demographics
NPI:1003989930
Name:HOLLADY, WENDY REBECCA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:REBECCA
Last Name:HOLLADY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N RIDE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5159
Mailing Address - Country:US
Mailing Address - Phone:850-508-7307
Mailing Address - Fax:
Practice Address - Street 1:1280 KISSIMMEE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310-0212
Practice Address - Country:US
Practice Address - Phone:850-575-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical