Provider Demographics
NPI:1720598295
Name:HOLLOWAY, KELLI NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:NICOLE
Last Name:HOLLOWAY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4844 BLOOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-3356
Mailing Address - Country:US
Mailing Address - Phone:901-215-8602
Mailing Address - Fax:
Practice Address - Street 1:1548 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2432
Practice Address - Country:US
Practice Address - Phone:901-272-0855
Practice Address - Fax:901-333-8255
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical