Provider Demographics
NPI:1528368206
Name:HOLLOWAY, CYNTHIA ELLEN (IMFT, LPN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ELLEN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:IMFT, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-0382
Mailing Address - Country:US
Mailing Address - Phone:937-524-4075
Mailing Address - Fax:
Practice Address - Street 1:1178 POND VIEW DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-7611
Practice Address - Country:US
Practice Address - Phone:937-524-4075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF1000009106H00000X
OHPN131155 MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse