Provider Demographics
NPI:1679028609
Name:HOLLIDAY, JAVA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JAVA
Middle Name:
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2955
Mailing Address - Country:US
Mailing Address - Phone:269-280-1011
Mailing Address - Fax:
Practice Address - Street 1:44 CLARK RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-7351
Practice Address - Country:US
Practice Address - Phone:296-280-1011
Practice Address - Fax:269-979-2841
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017158101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional