Provider Demographics
NPI:1104210905
Name:HOLLOWAY, DONNETTE NICOLE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DONNETTE
Middle Name:NICOLE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7618 W 59TH TER APT 314
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4417
Mailing Address - Country:US
Mailing Address - Phone:702-327-9789
Mailing Address - Fax:
Practice Address - Street 1:7940 PARALLEL PKWY STE 1
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2070
Practice Address - Country:US
Practice Address - Phone:913-908-6986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS82751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical