Healthcare Provider Details

I. General information

NPI: 1548269145
Provider Name (Legal Business Name): CARRIE HOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

PO BOX 631878
BALTIMORE MD
21263-1878
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-8609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1000069
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: