Basic Information
| Provider Information | |||||||||
| NPI: | 1407267917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMEEN | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | SUZANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38259 N FORK RD | ||||||||
| Address2: | |||||||||
| City: | PURCELLVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201325137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409552400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19420 GOLF VISTA PLZ STE 250 | ||||||||
| Address2: | |||||||||
| City: | LANSDOWNE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201768267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036217121 | ||||||||
| FaxNumber: | 7036657686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2014 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0701007061 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.