Provider Demographics
NPI:1841318789
Name:HOLLAND, REBECCA 'AMY' CLONINGER (MA, LPC)
Entity type:Individual
Prefix:
First Name:REBECCA 'AMY'
Middle Name:CLONINGER
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 CLONINGER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-8528
Mailing Address - Country:US
Mailing Address - Phone:704-813-0103
Mailing Address - Fax:
Practice Address - Street 1:3370 CLONINGER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-8528
Practice Address - Country:US
Practice Address - Phone:704-813-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional