Basic Information
| Provider Information | |||||||||
| NPI: | 1598340200 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLAR | ||||||||
| FirstName: | JORDAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 S REYNOLDS ST APT M120 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223044427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164652858 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 PENNSYLVANIA AVE SE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200034318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025445440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2021 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | PSYA00381 | DC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.