Provider Demographics
NPI:1962827329
Name:HOLLOWAY, JENNIFER CRISTIN (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CRISTIN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 LEESBURG PIKE
Mailing Address - Street 2:410
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2004
Mailing Address - Country:US
Mailing Address - Phone:703-506-1930
Mailing Address - Fax:
Practice Address - Street 1:7600 LEESBURG PIKE
Practice Address - Street 2:410
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2004
Practice Address - Country:US
Practice Address - Phone:703-506-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000018103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-06-3019OtherBCBA
VA0133000018OtherBCBA VA LICENSE