Provider Demographics
NPI:1891887717
Name:HOLLEY-CERILLO, MARY LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LEE
Last Name:HOLLEY-CERILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5675 STONE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1667
Mailing Address - Country:US
Mailing Address - Phone:703-830-9720
Mailing Address - Fax:703-830-6992
Practice Address - Street 1:5675 STONE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1667
Practice Address - Country:US
Practice Address - Phone:703-830-9720
Practice Address - Fax:703-830-6992
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040035511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical