Provider Demographics
NPI:1689561193
Name:TRAIL OF THE GIFTED INC.
Entity type:Organization
Organization Name:TRAIL OF THE GIFTED INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HOLLOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-876-4450
Mailing Address - Street 1:202 SCHEMBRI DR # 2108
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-5631
Mailing Address - Country:US
Mailing Address - Phone:757-876-4450
Mailing Address - Fax:
Practice Address - Street 1:202 SCHEMBRI DR # 2108
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-5631
Practice Address - Country:US
Practice Address - Phone:757-876-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-18
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health