Provider Demographics
NPI:1215517339
Name:HOLLOWAY, RAPHAEL (LPC)
Entity type:Individual
Prefix:MR
First Name:RAPHAEL
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5686 FULTON INDUSTRIAL BLVD SW
Mailing Address - Street 2:UNIT 44528
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30336
Mailing Address - Country:US
Mailing Address - Phone:404-914-4782
Mailing Address - Fax:404-914-4782
Practice Address - Street 1:2001 MARTIN LUTHER KING JR DR. SW
Practice Address - Street 2:SUITE 540
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-3031
Practice Address - Country:US
Practice Address - Phone:404-914-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004538101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional