Provider Demographics
NPI:1376618264
Name:MAY, HOLLY JEAN (MA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:JEAN
Last Name:MAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:JEAN
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3139 SIDNEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4430
Mailing Address - Country:US
Mailing Address - Phone:803-798-2574
Mailing Address - Fax:803-898-2194
Practice Address - Street 1:ALL OVER THE STATE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29202
Practice Address - Country:US
Practice Address - Phone:803-898-2025
Practice Address - Fax:803-898-2184
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health