Provider Demographics
NPI:1417169699
Name:HER-HOLLOWAY, MAI (LCSW)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:
Last Name:HER-HOLLOWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAI
Other - Middle Name:
Other - Last Name:HER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5680 MAPLETON WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-7243
Mailing Address - Country:US
Mailing Address - Phone:916-812-2117
Mailing Address - Fax:
Practice Address - Street 1:1515 S ST STE 125-S
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-7243
Practice Address - Country:US
Practice Address - Phone:916-602-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW792531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical