Provider Demographics
NPI:1700593159
Name:HOLLOWAY, DEMETRICIA ANN (CGC)
Entity Type:Individual
Prefix:
First Name:DEMETRICIA
Middle Name:ANN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:CGC
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 7281
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-7281
Mailing Address - Country:US
Mailing Address - Phone:409-229-8687
Mailing Address - Fax:
Practice Address - Street 1:5030 BIGNER RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-5203
Practice Address - Country:US
Practice Address - Phone:409-299-9034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor