Provider Demographics
NPI:1447808274
Name:HOLLOWAY, MONICA LATRIESE (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LATRIESE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10106 KRAUSE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6572
Mailing Address - Country:US
Mailing Address - Phone:804-991-8799
Mailing Address - Fax:
Practice Address - Street 1:10106 KRAUSE RD STE 206
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6572
Practice Address - Country:US
Practice Address - Phone:804-991-8799
Practice Address - Fax:804-777-7770
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008566101Y00000X, 101YM0800X, 101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA247726836Medicaid