Basic Information
| Provider Information | |||||||||
| NPI: | 1225176597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLIFIELD | ||||||||
| FirstName: | TALITHA | ||||||||
| MiddleName: | TAYLOR | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1167 SPRATLIN PARK DR | ||||||||
| Address2: | |||||||||
| City: | GRAY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376156205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234673600 | ||||||||
| FaxNumber: | 4234673644 | ||||||||
| Practice Location | |||||||||
| Address1: | 3169 2ND AVE E | ||||||||
| Address2: | |||||||||
| City: | BIG STONE GAP | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242193805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765238300 | ||||||||
| FaxNumber: | 4234673644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 01/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 0717000341LMFT | VA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YP2500X | 0701002203 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.