Provider Demographics
NPI:1811162910
Name:HOLLOWAY, DOROTHY JEAN (LPC, RN)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:JEAN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SW WILSON AVE STE 207
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3592
Mailing Address - Country:US
Mailing Address - Phone:541-771-3247
Mailing Address - Fax:541-617-0337
Practice Address - Street 1:210 SW WILSON AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3591
Practice Address - Country:US
Practice Address - Phone:541-771-3247
Practice Address - Fax:541-617-0337
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional