Provider Demographics
NPI:1770892556
Name:HOLLOWAY, DEWAYNA L (MFT I)
Entity type:Individual
Prefix:MS
First Name:DEWAYNA
Middle Name:L
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MFT I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S. MCDONNELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022
Mailing Address - Country:US
Mailing Address - Phone:323-981-4301
Mailing Address - Fax:
Practice Address - Street 1:1500 S. MCDONNELL AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022
Practice Address - Country:US
Practice Address - Phone:323-981-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2013-10-01
Deactivation Date:2011-10-12
Deactivation Code:
Reactivation Date:2013-10-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist