Provider Demographics
NPI:1972844413
Name:HOLLOWAY, SANDRA LEE (LPC (PHD GENETICS))
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LPC (PHD GENETICS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CLWYD RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2302
Mailing Address - Country:US
Mailing Address - Phone:610-660-0401
Mailing Address - Fax:
Practice Address - Street 1:6800 PARAGON PL STE 237
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1651
Practice Address - Country:US
Practice Address - Phone:804-562-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPMC1098101YP2500X
PAPC010948101YP2500X
VA0701014839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional