Provider Demographics
NPI:1013394212
Name:MANN, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MANN
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-0421
Mailing Address - Country:US
Mailing Address - Phone:910-622-3418
Mailing Address - Fax:
Practice Address - Street 1:13480 HWY 210/50
Practice Address - Street 2:SUITE 213
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445-6431
Practice Address - Country:US
Practice Address - Phone:910-622-3418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical