Provider Demographics
NPI:1639433360
Name:HOLLEY, DOMINIQUE STARR CROSBY (DO)
Entity type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:STARR CROSBY
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:DO
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 24449
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-0589
Mailing Address - Country:US
Mailing Address - Phone:833-351-8255
Mailing Address - Fax:
Practice Address - Street 1:315 DEADERICK ST STE 1550
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37238-3003
Practice Address - Country:US
Practice Address - Phone:833-351-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37962084A0401X, 2084P0804X, 2084P0800X
NY3274182084A0401X, 2084P0800X, 2084P0804X
VA01022037892084A0401X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry