Healthcare Provider Details

I. General information

NPI: 1265803670
Provider Name (Legal Business Name): HOLLIE BATEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 SHARON RD STE 201
KING WILLIAM VA
23086-3347
US

IV. Provider business mailing address

9228 GEORGE WASHINGTON MEMORIAL HWY ATTN: CREDENTIALING DEPT
GLOUCESTER VA
23061-4162
US

V. Phone/Fax

Practice location:
  • Phone: 804-769-2751
  • Fax: 804-769-3125
Mailing address:
  • Phone: 804-695-8119
  • Fax: 804-695-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006360
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: