Provider Demographics
NPI:1659625325
Name:HOLLOWAY, JENNIFER (MED, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:LOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA, LBA
Mailing Address - Street 1:49 QUINCY CT
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5755
Mailing Address - Country:US
Mailing Address - Phone:908-268-9437
Mailing Address - Fax:
Practice Address - Street 1:49 QUINCY CT
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5755
Practice Address - Country:US
Practice Address - Phone:908-268-9437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst