Provider Demographics
NPI:1710556931
Name:HOLLY, CORIE J (CPPSS)
Entity Type:Individual
Prefix:
First Name:CORIE
Middle Name:J
Last Name:HOLLY
Suffix:
Gender:F
Credentials:CPPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 GINN ALTMAN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924-3963
Mailing Address - Country:US
Mailing Address - Phone:803-943-2800
Mailing Address - Fax:803-943-2267
Practice Address - Street 1:102 GINN ALTMAN AVE STE C
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924-3963
Practice Address - Country:US
Practice Address - Phone:803-943-2800
Practice Address - Fax:803-943-2267
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)