Provider Demographics
NPI:1639658263
Name:HOLLAND, CHYA PAIGE
Entity Type:Individual
Prefix:
First Name:CHYA
Middle Name:PAIGE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 ANNESLEY CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-6497
Mailing Address - Country:US
Mailing Address - Phone:301-549-0021
Mailing Address - Fax:
Practice Address - Street 1:1831 FOREST DR STE H-2
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4430
Practice Address - Country:US
Practice Address - Phone:301-549-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional