Provider Demographics
NPI:1730567132
Name:MCNINCH, HOLLY (MA, LPC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MCNINCH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 GLENRIDGE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5572
Mailing Address - Country:US
Mailing Address - Phone:678-523-0025
Mailing Address - Fax:
Practice Address - Street 1:5885 GLENRIDGE DR STE 130
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5572
Practice Address - Country:US
Practice Address - Phone:678-523-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health