Healthcare Provider Details

I. General information

NPI: 1225848401
Provider Name (Legal Business Name): MITCHELL CHARLES HOLLOMAN QMHP, MPA, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
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 TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number$$$$$$$$$
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: