Provider Demographics
NPI:1073024535
Name:HOLLOWAY, DEANNA CHRISTINE (MFTI, PCCI)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:CHRISTINE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MFTI, PCCI
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:CHRISTINE
Other - Last Name:DUDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17852 SHOREHAM LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4838
Mailing Address - Country:US
Mailing Address - Phone:949-945-8147
Mailing Address - Fax:
Practice Address - Street 1:18700 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2030
Practice Address - Country:US
Practice Address - Phone:714-654-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102048106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist