Provider Demographics
NPI:1023351269
Name:SMOLEY, HOLLIE (BCABA)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:SMOLEY
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 MAROTTA LOOP
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5088
Mailing Address - Country:US
Mailing Address - Phone:321-228-7505
Mailing Address - Fax:407-877-1016
Practice Address - Street 1:751 MAROTTA LOOP
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-5088
Practice Address - Country:US
Practice Address - Phone:321-228-7505
Practice Address - Fax:407-877-1016
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-00-0116103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst