Healthcare Provider Details

I. General information

NPI: 1922770239
Provider Name (Legal Business Name): TACKYA HOILETT LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7474 GREENWAY CENTER DR STE 202
GREENBELT MD
20770-3504
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 202
GREENBELT MD
20770-3504
US

V. Phone/Fax

Practice location:
  • Phone: 240-304-3327
  • Fax:
Mailing address:
  • Phone: 240-304-3327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC12328
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP10139
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: