Provider Demographics
NPI:1225848401
Name:HOLLOMAN, MITCHELL CHARLES
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:CHARLES
Last Name:HOLLOMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SCHEMBRI DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-5631
Mailing Address - Country:US
Mailing Address - Phone:757-876-4450
Mailing Address - Fax:
Practice Address - Street 1:202 SCHEMBRI DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-5631
Practice Address - Country:US
Practice Address - Phone:757-876-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA$$$$$$$$$405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No405300000XOther Service ProvidersPrevention Professional