Healthcare Provider Details

I. General information

NPI: 1346041043
Provider Name (Legal Business Name): LAKISHA HOLLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 NORFOLK SQ
NORFOLK VA
23502-3234
US

IV. Provider business mailing address

1003 NORFOLK SQ
NORFOLK VA
23502-3234
US

V. Phone/Fax

Practice location:
  • Phone: 757-622-0700
  • Fax: 757-622-2400
Mailing address:
  • Phone: 757-622-0700
  • Fax: 757-622-2400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701014429
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: