Provider Demographics
NPI:1770609018
Name:HOLLER, JOHN EMORY JR (LPC, LMFT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EMORY
Last Name:HOLLER
Suffix:JR
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 MILLWOOD AVE
Mailing Address - Street 2:PO BOX 50466
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1359
Mailing Address - Country:US
Mailing Address - Phone:803-256-7394
Mailing Address - Fax:803-212-4798
Practice Address - Street 1:2900 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1359
Practice Address - Country:US
Practice Address - Phone:803-256-7394
Practice Address - Fax:803-212-4798
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1418101Y00000X
SC1503106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist