Provider Demographics
NPI:1245597376
Name:LOVE-HOLLIDAY, DESIREE
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:
Last Name:LOVE-HOLLIDAY
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 1:3519 SW 69TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6029
Mailing Address - Country:US
Mailing Address - Phone:754-244-7088
Mailing Address - Fax:
Practice Address - Street 1:3519 SW 69TH WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6029
Practice Address - Country:US
Practice Address - Phone:754-244-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral