Provider Demographics
NPI:1568200350
Name:HOLLIS, FELECIA DEWAYNE (COUNSELING PSYCHOLOG)
Entity type:Individual
Prefix:
First Name:FELECIA
Middle Name:DEWAYNE
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:COUNSELING PSYCHOLOG
Other - Prefix:
Other - First Name:FELECIA
Other - Middle Name:DEWAYNE
Other - Last Name:HOLLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187-0366
Mailing Address - Country:US
Mailing Address - Phone:470-531-4626
Mailing Address - Fax:
Practice Address - Street 1:1836 CARROLLTON VILLA RICA HWY STE 204
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-5194
Practice Address - Country:US
Practice Address - Phone:253-328-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral