Active NPI
Brenda Mae Hollis
- Social Worker
- Augusta, GA
National Provider Identifier
1144409798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- MSW004452
- Practice address
- 1 Freedom Way
Augusta, GA 30904-6258 - Phone
- (706) 733-0188
- Fax
- (706) 823-3952
- NPI assigned
- Oct 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC004721 | GA | |
| Social Worker | 104100000X | MSW004452 | GA | Primary |
Addresses
Primary practice location
1 Freedom Way
Augusta, GA 30904-6258
Mailing address
4133 Fox Brush Dr
Evans, GA 30809-4882
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC004721 | GA | MD | Professional Counselor |
| MSW004452 | GA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193788800000",
"number": "1144409798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4133 FOX BRUSH DR",
"city": "EVANS",
"state": "GA",
"postal_code": "308094882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 FREEDOM WAY",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309046258",
"telephone_number": "706-733-0188",
"fax_number": "706-823-3952"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLIS",
"first_name": "BRENDA",
"middle_name": "MAE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-31",
"last_updated": "2007-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC004721",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "GA",
"license": "MSW004452",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.