Provider Demographics
NPI:1407058175
Name:BRENDA B HOLLIS, LPC, PC
Entity Type:Organization
Organization Name:BRENDA B HOLLIS, LPC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-638-0180
Mailing Address - Street 1:PO BOX 21133
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-0633
Mailing Address - Country:US
Mailing Address - Phone:912-638-0180
Mailing Address - Fax:912-638-0181
Practice Address - Street 1:1626 FREDERICA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2529
Practice Address - Country:US
Practice Address - Phone:912-638-0180
Practice Address - Fax:912-638-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC000819101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty