Provider Demographics
NPI:1861845489
Name:HOLEMAN HOUSE LLC
Entity Type:Organization
Organization Name:HOLEMAN HOUSE LLC
Other - Org Name:HOLEMAN HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-576-0665
Mailing Address - Street 1:207 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-5129
Mailing Address - Country:US
Mailing Address - Phone:757-576-0665
Mailing Address - Fax:434-260-5262
Practice Address - Street 1:207 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-5129
Practice Address - Country:US
Practice Address - Phone:757-576-0665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health