Healthcare Provider Details

I. General information

NPI: 1063485910
Provider Name (Legal Business Name): AMY NOEL HOLLEMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 BREMO RD SUITE 101
RICHMOND VA
23226-2438
US

IV. Provider business mailing address

2006 BREMO RD SUITE 101
RICHMOND VA
23226-2438
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-1881
  • Fax: 804-282-6413
Mailing address:
  • Phone: 804-288-1881
  • Fax: 804-282-6413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003583
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: