Provider Demographics
NPI:1942965777
Name:HOLLEY, ANITA BEATRICE
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:BEATRICE
Last Name:HOLLEY
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 1:2011 ANGLER CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-5345
Mailing Address - Country:US
Mailing Address - Phone:757-692-8526
Mailing Address - Fax:757-337-8215
Practice Address - Street 1:2011 ANGLER CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-5345
Practice Address - Country:US
Practice Address - Phone:757-692-8526
Practice Address - Fax:757-337-8215
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014398101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor