Provider Demographics
NPI:1114382900
Name:HOLLY, LOLITA
Entity Type:Individual
Prefix:MRS
First Name:LOLITA
Middle Name:
Last Name:HOLLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MOZART DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-7981
Mailing Address - Country:US
Mailing Address - Phone:985-209-0983
Mailing Address - Fax:985-223-2875
Practice Address - Street 1:401 MOZART DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-7981
Practice Address - Country:US
Practice Address - Phone:985-209-0983
Practice Address - Fax:985-223-2875
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health