Provider Demographics
NPI:1326643685
Name:HOLLOWAY, PENELOPE ANNE (MA,BCBA)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:ANNE
Last Name:HOLLOWAY
Suffix:
Gender:
Credentials:MA,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7288 HANOVER GREEN DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-1709
Mailing Address - Country:US
Mailing Address - Phone:888-254-7099
Mailing Address - Fax:
Practice Address - Street 1:7288 HANOVER GREEN DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1709
Practice Address - Country:US
Practice Address - Phone:888-254-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-20-46316103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty