Healthcare Provider Details

I. General information

NPI: 1598681991
Provider Name (Legal Business Name): TARA DAWN HOLLEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W PRATT ST FL 2
BALTIMORE MD
21223-2679
US

IV. Provider business mailing address

1139 SKYWAY DR
ANNAPOLIS MD
21409-4902
US

V. Phone/Fax

Practice location:
  • Phone: 843-231-6887
  • Fax:
Mailing address:
  • Phone: 843-231-6887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: