Provider Demographics
NPI:1407500481
Name:TUDOR, HOLLY D (LPC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:D
Last Name:TUDOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 GUNBY DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-7029
Mailing Address - Country:US
Mailing Address - Phone:804-273-7531
Mailing Address - Fax:
Practice Address - Street 1:4907 FITZHUGH AVE STE 202
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3533
Practice Address - Country:US
Practice Address - Phone:804-273-7531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional