Healthcare Provider Details

I. General information

NPI: 1386763324
Provider Name (Legal Business Name): HOLLY LYNNE DALY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5352 TWIN HICKORY RD RESOURCE GUIDANCE SERVICES
GLEN ALLEN VA
23059-5682
US

IV. Provider business mailing address

5352 TWIN HICKORY RD RESOURCE GUIDANCE SERVICES
GLEN ALLEN VA
23059-5682
US

V. Phone/Fax

Practice location:
  • Phone: 804-592-2793
  • Fax: 804-592-2794
Mailing address:
  • Phone: 804-592-2793
  • Fax: 804-592-2794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101251772
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA86463
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA86463
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101251772
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: