Healthcare Provider Details

I. General information

NPI: 1316242571
Provider Name (Legal Business Name): TAWANA MARIE HOLLAND LCSW-C, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 PORT ECHO LN
BOWIE MD
20716-1842
US

IV. Provider business mailing address

1228 PORT ECHO LN
BOWIE MD
20716-1842
US

V. Phone/Fax

Practice location:
  • Phone: 240-394-2516
  • Fax: 301-249-7762
Mailing address:
  • Phone: 240-394-2516
  • Fax: 301-249-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10682
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC303391
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: