Provider Demographics
NPI:1467267195
Name:HALE, HOLLY LYNN (RBT)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:LYNN
Last Name:HALE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5944 CARROLL RD
Mailing Address - Street 2:
Mailing Address - City:COEBURN
Mailing Address - State:VA
Mailing Address - Zip Code:24230-5230
Mailing Address - Country:US
Mailing Address - Phone:951-966-4685
Mailing Address - Fax:
Practice Address - Street 1:5944 CARROLL RD
Practice Address - Street 2:
Practice Address - City:COEBURN
Practice Address - State:VA
Practice Address - Zip Code:24230-5230
Practice Address - Country:US
Practice Address - Phone:951-966-4685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-24-351193103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst