Provider Demographics
NPI:1922680164
Name:HOLLOWAY, DAVONDA MICHELLE (MSW,LCSW-A)
Entity Type:Individual
Prefix:
First Name:DAVONDA
Middle Name:MICHELLE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MSW,LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S WESTGATE DR STE D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1632
Mailing Address - Country:US
Mailing Address - Phone:434-429-7892
Mailing Address - Fax:
Practice Address - Street 1:319 S WESTGATE DR STE D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1632
Practice Address - Country:US
Practice Address - Phone:866-700-1606
Practice Address - Fax:866-338-5921
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0151601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty