Provider Demographics
NPI:1508645524
Name:HOLLEY, DONISHA SHAWNETTA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DONISHA
Middle Name:SHAWNETTA
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BROADLEAF DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-4501
Mailing Address - Country:US
Mailing Address - Phone:252-267-2457
Mailing Address - Fax:
Practice Address - Street 1:2740 PROSPERITY AVE STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4354
Practice Address - Country:US
Practice Address - Phone:571-623-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040154031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical