Healthcare Provider Details

I. General information

NPI: 1013050988
Provider Name (Legal Business Name): HOLLY LYNN SNYDER GENETIC COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1929
US

IV. Provider business mailing address

500 J. CLYDE MORRIS BOULEVARD BUILDING G, SUITE 200
NEWPORT NEWS VA
23601
US

V. Phone/Fax

Practice location:
  • Phone: 757-494-3636
  • Fax: 757-624-2272
Mailing address:
  • Phone: 757-534-5791
  • Fax: 757-594-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number2005129
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: