Provider Demographics
NPI:1699403683
Name:HOLLOWAY, ANTHONY JAMES (RADT-I)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAMES
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 S BELARDO RD APT 603
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-8313
Mailing Address - Country:US
Mailing Address - Phone:760-409-1992
Mailing Address - Fax:
Practice Address - Street 1:1330 N INDIAN CANYON DR STE A
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4880
Practice Address - Country:US
Practice Address - Phone:760-322-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARH0009180722101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)