Provider Demographics
NPI:1558011924
Name:HOLLOMAN, CHARMAYNE
Entity Type:Individual
Prefix:
First Name:CHARMAYNE
Middle Name:
Last Name:HOLLOMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 CRAIGMOSS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6672
Mailing Address - Country:US
Mailing Address - Phone:678-733-4585
Mailing Address - Fax:
Practice Address - Street 1:4515 CRAIGMOSS LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-6672
Practice Address - Country:US
Practice Address - Phone:678-733-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator