Provider Demographics
NPI:1396144713
Name:HOLLOWAY, KELLEY ANN (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:ANN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:KELLEY
Other - Middle Name:HOLLOWAY
Other - Last Name:WOOTTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:10344 OLD OCEAN CITY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1162
Practice Address - Country:US
Practice Address - Phone:410-641-3340
Practice Address - Fax:410-641-3341
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD200051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
MD211862Medicare Oscar/Certification
MDS118Medicare PIN