Provider Demographics
NPI:1073872800
Name:HOLLOWAY, WILLIAM (LCAT, LPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:LCAT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 NE GOING ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4642
Mailing Address - Country:US
Mailing Address - Phone:917-407-9641
Mailing Address - Fax:
Practice Address - Street 1:1122 NE GOING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-4642
Practice Address - Country:US
Practice Address - Phone:917-407-9641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5988101YP2500X
ORC7186101YP2500X
NY001114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health