Provider Information for 1699953125
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JACKIE HOLLIDAY LPC
Sex: Female
NPI: 1699953125
Last Updated: 2008-09-24
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1699953125 | ||||||||
| Enumeration Date | 2008-02-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1246-C CONCORD ROAD SUITE 103 SMYRNA, GA 30080 United States Phone: 770-422-4082 | Fax:770-422-4082 | ||||||||
| Primary Practice Address | 1246 BUILD C CONCORD ROAD SUITE 103 SMYRNA, GA 30080 United States Phone: 770-422-4082 | Fax:770-422-4082 | ||||||||
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