Provider Demographics
NPI:1346528338
Name:HOLLOWAY, MICHELE ASHLEY (BA, LMT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ASHLEY
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:BA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 N SPRING GARDEN AVE
Mailing Address - Street 2:SUITE 163
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0900
Mailing Address - Country:US
Mailing Address - Phone:386-216-3491
Mailing Address - Fax:
Practice Address - Street 1:929 N SPRING GARDEN AVE
Practice Address - Street 2:SUITE 163
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0900
Practice Address - Country:US
Practice Address - Phone:386-216-3491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#37351171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor