Provider Demographics
NPI:1003679549
Name:HOLLOWAY, MONA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MONA
Middle Name:MARIE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15353 WINSOR PL
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-3018
Mailing Address - Country:US
Mailing Address - Phone:228-326-8315
Mailing Address - Fax:
Practice Address - Street 1:1520 29TH AVE STE 36
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2843
Practice Address - Country:US
Practice Address - Phone:228-591-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC108811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical