Healthcare Provider Details

I. General information

NPI: 1306470141
Provider Name (Legal Business Name): JAMICE AMANDA HOLLEY LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 PROFESSIONAL BLVD STE A
CROFTON MD
21114-2049
US

IV. Provider business mailing address

7606 ELMCREST RD
HANOVER MD
21076-1873
US

V. Phone/Fax

Practice location:
  • Phone: 301-875-5429
  • Fax:
Mailing address:
  • Phone: 240-599-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC13761
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC13761
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC13761
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: