Provider Demographics
NPI:1194290007
Name:HOLLOWAY, CATHERINE MELISSA (LMSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MELISSA
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:MELISSA
Other - Last Name:COLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2141 CUNNINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-8830
Mailing Address - Country:US
Mailing Address - Phone:931-801-6021
Mailing Address - Fax:
Practice Address - Street 1:2141 CUNNINGHAM RD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-8830
Practice Address - Country:US
Practice Address - Phone:931-801-6021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-06
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9217104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9217OtherLICENCE OF MASTER SOCIAL WORKER