Provider Demographics
NPI:1346333911
Name:HOLLADAY, DEBORAH LEE (MS ED)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEE
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 EVERGREEN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1489
Mailing Address - Country:US
Mailing Address - Phone:502-599-3593
Mailing Address - Fax:502-565-1887
Practice Address - Street 1:130 EVERGREEN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1489
Practice Address - Country:US
Practice Address - Phone:502-599-3593
Practice Address - Fax:502-565-1887
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1066101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-1066OtherKENTUCKY LICENSE LICENSED PROFESSIONAL CLINICAL COUNSELOR