Provider Demographics
NPI:1225231863
Name:HOLLOWAY, KIDADA MELVINA (LPC)
Entity Type:Individual
Prefix:MS
First Name:KIDADA
Middle Name:MELVINA
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2434
Mailing Address - Country:US
Mailing Address - Phone:828-582-3726
Mailing Address - Fax:
Practice Address - Street 1:68 GROVE ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3204
Practice Address - Country:US
Practice Address - Phone:828-528-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health