Healthcare Provider Details

I. General information

NPI: 1619784584
Provider Name (Legal Business Name): KEIASIA HOLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2024
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 WISE RD
HAMPTON VA
23663-1041
US

IV. Provider business mailing address

2118 WISE RD
HAMPTON VA
23663-1041
US

V. Phone/Fax

Practice location:
  • Phone: 646-701-3010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101YM0800X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: