Healthcare Provider Details

I. General information

NPI: 1285108043
Provider Name (Legal Business Name): RENICE L WILEY-HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6139 OXON HILL RD # 1195
OXON HILL MD
20745-3108
US

IV. Provider business mailing address

6139 OXON HILL RD # 1195
OXON HILL MD
20745-3108
US

V. Phone/Fax

Practice location:
  • Phone: 973-259-6082
  • Fax:
Mailing address:
  • Phone: 973-259-6082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32511
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06164100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904015415
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number093602
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200002524
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: