Healthcare Provider Details

I. General information

NPI: 1578350054
Provider Name (Legal Business Name): HOLLY VAN WINTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 WISCONSIN AVE STE 203
BETHESDA MD
20815-3524
US

IV. Provider business mailing address

1459 HARVARD ST NW APT 4
WASHINGTON DC
20009-4738
US

V. Phone/Fax

Practice location:
  • Phone: 301-807-3416
  • Fax:
Mailing address:
  • Phone: 205-240-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: