Provider Demographics
NPI:1821661968
Name:HOLLOWAY, BOBBIE LAYNE
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:LAYNE
Last Name:HOLLOWAY
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 1:12 RIVERGATE DR
Mailing Address - Street 2:
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1312
Mailing Address - Country:US
Mailing Address - Phone:757-876-8616
Mailing Address - Fax:
Practice Address - Street 1:12 RIVERGATE DR
Practice Address - Street 2:
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-1312
Practice Address - Country:US
Practice Address - Phone:757-876-8616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-21-175957106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician