Provider Demographics
NPI:1932574134
Name:SPENCE-HOLLIMAN, LADONNA (LMT)
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:
Last Name:SPENCE-HOLLIMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:HOLLIMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:16 PARKWAY
Mailing Address - Street 2:APT D
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1861
Mailing Address - Country:US
Mailing Address - Phone:301-830-3542
Mailing Address - Fax:301-477-3315
Practice Address - Street 1:10313 GEORGIA AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5006
Practice Address - Country:US
Practice Address - Phone:301-830-3542
Practice Address - Fax:301-477-3315
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMO4985225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist