Provider Demographics
NPI:1407024524
Name:HOLLOWAY, NICCI (PSY D, LMHC)
Entity Type:Individual
Prefix:DR
First Name:NICCI
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:PSY D, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 N DILLARD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2861
Mailing Address - Country:US
Mailing Address - Phone:407-702-1141
Mailing Address - Fax:
Practice Address - Street 1:446 N DILLARD ST STE 2
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2861
Practice Address - Country:US
Practice Address - Phone:407-702-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health