MEDICARE: LAKISHA HOLLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701014429	VA

General Provider Information

NPI Number	:	1346041043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKISHA HOLLEY

Provider Business Mailing Address
First Line	:	1003 NORFOLK SQ
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-3234
Country	:	US
Telephone Number	:	757-622-0700
Fax Number	:	757-622-2400

Provider Business Practice Location Address
First Line	:	1003 NORFOLK SQ
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-3234
Country	:	US
Telephone Number	:	757-622-0700
Fax Number	:	757-622-2400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	03/20/2025

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Directions to “ LAKISHA HOLLEY ” Practice Location

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