Provider Demographics
NPI:1477197143
Name:AYERS, HOLLY DAWNIELLE
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:DAWNIELLE
Last Name:AYERS
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 1:425 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5320
Mailing Address - Country:US
Mailing Address - Phone:757-974-9804
Mailing Address - Fax:
Practice Address - Street 1:425 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5320
Practice Address - Country:US
Practice Address - Phone:757-974-9804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst