Provider Demographics
NPI:1215493309
Name:HOLLOWAY, NATAYSIA APRIELLE (MS, ALC)
Entity type:Individual
Prefix:
First Name:NATAYSIA
Middle Name:APRIELLE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MS, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 PATTIWAY DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:AL
Mailing Address - Zip Code:36250-6219
Mailing Address - Country:US
Mailing Address - Phone:256-239-0228
Mailing Address - Fax:
Practice Address - Street 1:331 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5731
Practice Address - Country:US
Practice Address - Phone:256-236-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3256101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3256OtherCOUNSELING LICENSE NUMBER