Provider Demographics
NPI:1275912404
Name:HOLLIMON, AMY SMITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SMITH
Last Name:HOLLIMON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2525
Mailing Address - Country:US
Mailing Address - Phone:251-284-1843
Mailing Address - Fax:
Practice Address - Street 1:301 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2525
Practice Address - Country:US
Practice Address - Phone:251-284-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1969103TC1900X
IN20042150A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling