Provider Demographics
NPI:1083083794
Name:HOLLIDAY, SUSAN ELLEN (MSW, LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELLEN
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10451 TWIN RIVERS ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2388
Mailing Address - Country:US
Mailing Address - Phone:410-997-3557
Mailing Address - Fax:410-964-1791
Practice Address - Street 1:3405 BANTRY WAY
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2251
Practice Address - Country:US
Practice Address - Phone:301-570-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health