Individual
AMANDA HOLLOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
150 MEDICAL WAY, RIVERDALE, GA 30274-2533
(404) 709-8373
Mailing address
150 MEDICAL WAY, RIVERDALE, GA 30274-2533
(404) 709-8373
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC008361
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13678783
CAQH
GA
Enumeration date
02/01/2016
Last updated
02/01/2016
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