1073039962 NPI number — SHARON YVETTE HOLLOWAY MSW, PCMHT

Table of content: SHARON YVETTE HOLLOWAY MSW, PCMHT (NPI 1073039962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073039962 NPI number — SHARON YVETTE HOLLOWAY MSW, PCMHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLOWAY
Provider First Name:
SHARON
Provider Middle Name:
YVETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, PCMHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073039962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
152 HWY SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-234-7521
Provider Business Mailing Address Fax Number:
662-236-3071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
152 HWY AND SOUTH, OXFORD, MS 38655
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-234-7521
Provider Business Practice Location Address Fax Number:
662-236-3071
Provider Enumeration Date:
08/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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