Provider Demographics
NPI:1114545563
Name:HOLLINGSWORTH, JAMES KENNETH
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KENNETH
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 CLARK ST # A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5341
Mailing Address - Country:US
Mailing Address - Phone:910-590-7097
Mailing Address - Fax:
Practice Address - Street 1:2577 RAVENHILL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5451
Practice Address - Country:US
Practice Address - Phone:910-438-0947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional