Provider Demographics
NPI:1073093316
Name:HOLEMON, JANICE A (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:A
Last Name:HOLEMON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1831
Mailing Address - Country:US
Mailing Address - Phone:757-577-2100
Mailing Address - Fax:757-304-9423
Practice Address - Street 1:808 GARDNER ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1831
Practice Address - Country:US
Practice Address - Phone:757-577-2100
Practice Address - Fax:757-304-9423
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001502106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601309828Medicaid