Healthcare Provider Details

I. General information

NPI: 1689561193
Provider Name (Legal Business Name): TRAIL OF THE GIFTED INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 CITY CENTER BLVD STE C
NEWPORT NEWS VA
23606-3090
US

IV. Provider business mailing address

734 CITY CENTER BLVD STE C
NEWPORT NEWS VA
23606-3090
US

V. Phone/Fax

Practice location:
  • Phone: 757-876-4450
  • Fax:
Mailing address:
  • Phone: 757-876-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELL CHARLES HOLLOMAN
Title or Position: CEO
Credential: PHD
Phone: 757-876-4450