Provider Demographics
NPI:1922257914
Name:HOLLY, CATHERINE A (RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:CATHERINE
Middle Name:A
Last Name:HOLLY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SIMONS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-3751
Mailing Address - Country:US
Mailing Address - Phone:843-475-8010
Mailing Address - Fax:
Practice Address - Street 1:54 SIMONS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-3751
Practice Address - Country:US
Practice Address - Phone:843-475-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC573133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered