Provider Demographics
NPI:1679604987
Name:HOLLOWAY, THERESA (LCPC)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 GREEN MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048
Mailing Address - Country:US
Mailing Address - Phone:443-803-6571
Mailing Address - Fax:
Practice Address - Street 1:904 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5827
Practice Address - Country:US
Practice Address - Phone:410-751-9205
Practice Address - Fax:410-356-4459
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health