Provider Demographics
NPI:1639528243
Name:TAYLOR, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:TAYLOR
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 1:464 WOODHOUSE LOOP
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7780
Mailing Address - Country:US
Mailing Address - Phone:803-719-2559
Mailing Address - Fax:
Practice Address - Street 1:6334 SAINT ANDREWS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3143
Practice Address - Country:US
Practice Address - Phone:803-764-0961
Practice Address - Fax:803-764-0961
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional