Provider Demographics
NPI:1518259894
Name:HOLLOMAN, EMMY CLARK (MS, CRC, LCAS-P)
Entity Type:Individual
Prefix:MRS
First Name:EMMY
Middle Name:CLARK
Last Name:HOLLOMAN
Suffix:
Gender:F
Credentials:MS, CRC, LCAS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 JONES SMITH RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-9103
Mailing Address - Country:US
Mailing Address - Phone:336-964-0082
Mailing Address - Fax:
Practice Address - Street 1:6026 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3899
Practice Address - Country:US
Practice Address - Phone:919-865-8710
Practice Address - Fax:919-977-9760
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-2462101YA0400X
NC11831101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)