Provider Demographics
NPI:1659090223
Name:HOLLOWAY, CHARMAINE (RCPRS)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:RCPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 GAUNTLET DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-2810
Mailing Address - Country:US
Mailing Address - Phone:757-944-7071
Mailing Address - Fax:
Practice Address - Street 1:1104 GAUNTLET DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-2810
Practice Address - Country:US
Practice Address - Phone:757-944-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 171400000X
VA0735000509175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Yes175T00000XOther Service ProvidersPeer Specialist