Individual
MELISSA DAWN HOLLOMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW-CP & AP
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
4989
SC
101YA0400X
Addiction (Substance Use Disorder) Counselor
4989
SC
101YM0800X
Mental Health Counselor
4989
SC
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
4989
SC
104100000X
Social Worker
4989
SC
1041C0700X
Clinical Social Worker
Primary
4989
SC
106H00000X
Marriage & Family Therapist
4989
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q322560281
MEDICARE
SC
Enumeration date
10/17/2007
Last updated
06/11/2014
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