MR. Thadeus Mandrall Holloway, LPC

NPI #1245597848 in Mount Vernon, Georgia

Provider Information

NPI Number: 1245597848
Entity Type: Individual
Name: MR. Thadeus Mandrall Holloway, LPC
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor - Professional
Credential: LPC
Enumeration Date: Apr 19, 2012
Last Updated: Oct 20, 2014

Practice Location

Address: 305 W SPRING ST
Address 2: BOX 172
City: Mount Vernon
State: Georgia
ZIP Code: 30445-2837
Phone: (912) 423-1000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X
Counselor - Mental Health — Mental Health	101YM0800X
Counselor - Professional — Professional	101YP2500X	Primary

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