Healthcare Provider Details

I. General information

NPI: 1801611520
Provider Name (Legal Business Name): WHITTNI HOLLAND LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SOLOMONS ISLAND RD N
PRINCE FREDERICK MD
20678-3917
US

IV. Provider business mailing address

105 BOOTHHAVEN LN
OWINGS MD
20736-3172
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number25671
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: