MEDICARE: MS. SANDRA K. HOLLEY LPC

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	101YM0800X	Mental Health Counselor	PRC13889	DC

General Provider Information

NPI Number	:	1497923452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA K. HOLLEY LPC

Provider Business Mailing Address
First Line	:	1625 K ST NW
Second Line	:	SUITE 310
City	:	WASHINGTON
State	:	DC
Zip	:	20006-1604
Country	:	US
Telephone Number	:	703-929-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 K ST NW
Second Line	:	SUITE 310
City	:	WASHINGTON
State	:	DC
Zip	:	20006-1604
Country	:	US
Telephone Number	:	703-929-7000
Fax Number	:

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

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/13/2008

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