Provider Demographics
NPI:1952098246
Name:HOLLOWAY, MAHOGANY NASHAY (RADT)
Entity Type:Individual
Prefix:
First Name:MAHOGANY
Middle Name:NASHAY
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 K ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-4027
Mailing Address - Country:US
Mailing Address - Phone:707-676-0543
Mailing Address - Fax:
Practice Address - Street 1:7225 E SOUTHGATE DR STE D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2651
Practice Address - Country:US
Practice Address - Phone:916-394-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1503870423101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)