Provider Demographics
NPI:1669169165
Name:KEMZAN, HOLLICIA HOLLY-ANN
Entity type:Individual
Prefix:MRS
First Name:HOLLICIA
Middle Name:HOLLY-ANN
Last Name:KEMZAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:HOLLICIA
Other - Middle Name:HOLLY-ANN
Other - Last Name:COOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:506 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2512
Mailing Address - Country:US
Mailing Address - Phone:615-560-6622
Mailing Address - Fax:
Practice Address - Street 1:506 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2512
Practice Address - Country:US
Practice Address - Phone:615-560-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician