Provider Demographics
NPI:1699953125
Name:HOLLIDAY, JACKIE (LPC)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246-C CONCORD ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:770-422-4082
Mailing Address - Fax:770-422-4082
Practice Address - Street 1:1246 BUILD C CONCORD ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:770-422-4082
Practice Address - Fax:770-422-4082
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA004904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional