Provider Demographics
NPI:1124252465
Name:HOLLOWAY, HEIDI B (MA,LPC,PCMH)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:B
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MA,LPC,PCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 37
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19373-0037
Mailing Address - Country:US
Mailing Address - Phone:610-620-4991
Mailing Address - Fax:
Practice Address - Street 1:516 W UNION ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-3333
Practice Address - Country:US
Practice Address - Phone:610-620-4991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000575101YM0800X
PAPC002847101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health