Provider Demographics
NPI:1366762619
Name:HOLLOWAY, DENISE RAE (MHA,LSW)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:RAE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MHA,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 AKRON RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7904
Mailing Address - Country:US
Mailing Address - Phone:330-264-3232
Mailing Address - Fax:
Practice Address - Street 1:3445 S MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-3028
Practice Address - Country:US
Practice Address - Phone:330-245-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0010588104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker