Healthcare Provider Details

I. General information

NPI: 1043177892
Provider Name (Legal Business Name): JOHN KEMP HOLLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JACK HOLLAND

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7939 HONEYGO BLVD STE 224
NOTTINGHAM MD
21236-5992
US

IV. Provider business mailing address

9505 MIDARO CT
NOTTINGHAM MD
21236-4830
US

V. Phone/Fax

Practice location:
  • Phone: 410-933-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: