Provider Demographics
NPI:1316015969
Name:HOLLOWAY, KENIKA
Entity Type:Individual
Prefix:
First Name:KENIKA
Middle Name:
Last Name:HOLLOWAY
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 1:2031 GEES MILL RD NE STE 102
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1328
Mailing Address - Country:US
Mailing Address - Phone:833-299-4846
Mailing Address - Fax:833-299-4846
Practice Address - Street 1:2031 GEES MILL RD NE STE 102
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1328
Practice Address - Country:US
Practice Address - Phone:833-299-4846
Practice Address - Fax:833-299-4846
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional