Healthcare Provider Details

I. General information

NPI: 1801932900
Provider Name (Legal Business Name): HOLLY HARTSON-BOWYER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 FERRUM DR
SALEM VA
24153-7123
US

IV. Provider business mailing address

205 S WHITING ST STE 312
ALEXANDRIA VA
22304-3632
US

V. Phone/Fax

Practice location:
  • Phone: 703-249-5160
  • Fax:
Mailing address:
  • Phone: 703-249-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY18658
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005581
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: