Provider Demographics
NPI:1285859397
Name:HOLLOWAY, ANNETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PEPPER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1117
Mailing Address - Country:US
Mailing Address - Phone:415-843-1453
Mailing Address - Fax:
Practice Address - Street 1:9 PEPPER WAY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1117
Practice Address - Country:US
Practice Address - Phone:415-843-1453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25056103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical