MEDICARE: MRS. MONICA LATRIESE HOLLOWAY LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	0701008566	VA
2	101YM0800X	Mental Health Counselor	0701008566	VA
3	101YP2500X	Professional Counselor
4	101YP2500X	Professional Counselor	0701008566	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447808274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONICA LATRIESE HOLLOWAY LPC, NCC

Provider Business Mailing Address
First Line	:	10106 KRAUSE RD STE 206
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6572
Country	:	US
Telephone Number	:	804-991-8799
Fax Number	:

Provider Business Practice Location Address
First Line	:	10106 KRAUSE RD STE 206
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6572
Country	:	US
Telephone Number	:	804-991-8799
Fax Number	:	804-777-7770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	04/20/2020

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Directions to “ MRS. MONICA LATRIESE HOLLOWAY LPC, NCC” Practice Location

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