Provider Demographics
NPI:1598097040
Name:HOLLADAY, ANDREA L (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 S FLORIDA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4910
Mailing Address - Country:US
Mailing Address - Phone:863-937-8067
Mailing Address - Fax:863-937-8067
Practice Address - Street 1:5302 S FLORIDA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4922
Practice Address - Country:US
Practice Address - Phone:863-937-8067
Practice Address - Fax:863-937-8067
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-04-1686103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst