Healthcare Provider Details

I. General information

NPI: 1790595866
Provider Name (Legal Business Name): PIA S HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17152 THE TRAIL
KING AND QUEEN CH VA
28085
US

IV. Provider business mailing address

204 JOANNE DR
SEAFORD VA
23696-2447
US

V. Phone/Fax

Practice location:
  • Phone: 804-785-5830
  • Fax:
Mailing address:
  • Phone: 757-810-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberPPS-0604747
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: