Provider Demographics
NPI:1043778822
Name:HOLDREN, PATIENCE MARIE (BCABA, LABA)
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:MARIE
Last Name:HOLDREN
Suffix:
Gender:F
Credentials:BCABA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5296 PETERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-3808
Mailing Address - Country:US
Mailing Address - Phone:540-553-6423
Mailing Address - Fax:540-206-2109
Practice Address - Street 1:5296 PETERS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-3808
Practice Address - Country:US
Practice Address - Phone:540-215-0535
Practice Address - Fax:540-206-2109
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000241103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst