Provider Demographics
NPI:1528429511
Name:HOLLADAY, JENNIFER H (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 ALWYN CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-9764
Mailing Address - Country:US
Mailing Address - Phone:980-224-2857
Mailing Address - Fax:
Practice Address - Street 1:3109 ALWYN CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-9764
Practice Address - Country:US
Practice Address - Phone:980-224-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10070A106H00000X
NC1851106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist