Provider Demographics
NPI:1245840982
Name:SMITH, HOLLIE COLEMAN (MA)
Entity type:Individual
Prefix:MS
First Name:HOLLIE
Middle Name:COLEMAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:HOLLIE
Other - Middle Name:BRIANNE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:7984 NEW LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4718
Mailing Address - Country:US
Mailing Address - Phone:502-426-2777
Mailing Address - Fax:502-426-2776
Practice Address - Street 1:7984 NEW LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4718
Practice Address - Country:US
Practice Address - Phone:502-426-2777
Practice Address - Fax:502-426-2776
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261615103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist