Provider Demographics
NPI:1083750756
Name:HOLLIDAY, TINA F (MFT)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:F
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 PERALTA BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3959
Mailing Address - Country:US
Mailing Address - Phone:510-657-2300
Mailing Address - Fax:510-320-5439
Practice Address - Street 1:2140 PERALTA BLVD STE 112
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3959
Practice Address - Country:US
Practice Address - Phone:510-657-2300
Practice Address - Fax:510-320-5439
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39144106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist