Provider Demographics
NPI:1023259835
Name:MCCOLLISTER, HOLLIE KROHN (LPC)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:KROHN
Last Name:MCCOLLISTER
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 1:8942 ANAHOLA PL
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-4139
Mailing Address - Country:US
Mailing Address - Phone:228-326-3036
Mailing Address - Fax:
Practice Address - Street 1:415 W CANAL ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3912
Practice Address - Country:US
Practice Address - Phone:228-326-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional