Provider Demographics
NPI:1730391657
Name:HOLLOWAY, ANGELA (LMFT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2504
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92516
Mailing Address - Country:US
Mailing Address - Phone:909-770-0492
Mailing Address - Fax:909-204-5202
Practice Address - Street 1:8608 UTICA AVE STE 205
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4877
Practice Address - Country:US
Practice Address - Phone:909-770-0492
Practice Address - Fax:909-204-5202
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist