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General NPI Number Information
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NPI Number | 1053260554
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Entity Type | Individual
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Provider Name | HOLLY ELDRIDGE DUDLEY
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Gender | Female
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 9119 CHURCH ST
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City | MANASSAS
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State | VA
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Zip | 20110-5434
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Country | US
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Telephone | 571-261-8249
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Fax |
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Provider Business Mailing Address
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Address Line | 5979 AMBER RIDGE RD
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City | HAYMARKET
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State | VA
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Zip | 20169-2624
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704018873
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License Number State | VA
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