Healthcare Provider Details

I. General information

NPI: 1174434260
Provider Name (Legal Business Name): WAYLAND GREGORY HOLYFIELD LGPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 5TH ST NW
WASHINGTON DC
20011-4757
US

IV. Provider business mailing address

4710 5TH ST NW
WASHINGTON DC
20011-4757
US

V. Phone/Fax

Practice location:
  • Phone: 615-948-3294
  • Fax:
Mailing address:
  • Phone: 615-948-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC200012713
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: