Provider Demographics
NPI:1770215733
Name:POOLE, EDNA HOLLIDAY
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:HOLLIDAY
Last Name:POOLE
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 1:1850 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-5085
Mailing Address - Country:US
Mailing Address - Phone:803-783-0303
Mailing Address - Fax:
Practice Address - Street 1:5 KINLAUGH CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4431
Practice Address - Country:US
Practice Address - Phone:731-609-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health