Provider Demographics
NPI:1639265937
Name:HOLLIMAN, EVELYN CORNELIA (CONNIE HOLLIMAN)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:CORNELIA
Last Name:HOLLIMAN
Suffix:
Gender:F
Credentials:CONNIE HOLLIMAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1401 CUMBERLAND CT SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8658
Mailing Address - Country:US
Mailing Address - Phone:770-433-2088
Mailing Address - Fax:770-433-2088
Practice Address - Street 1:242 CREEKSTONE RDG
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3732
Practice Address - Country:US
Practice Address - Phone:678-445-4184
Practice Address - Fax:678-445-5146
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional