Active NPI
Jacquelynn Hollman
- Clinical Psychologist
- Leesburg, VA
National Provider Identifier
1710209952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810004223
- Practice address
- 42009 Victory LN
Leesburg, VA 20176-6269 - Phone
- (330) 758-4515
- Fax
- (330) 758-2862
- NPI assigned
- Feb 15, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810004223 | VA | Primary |
Addresses
Primary practice location
42009 Victory LN
Leesburg, VA 20176-6269
Mailing address
42009 Victory LN
Leesburg, VA 20176-6269
Phone (330) 758-4515
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810004223 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266192000000",
"number": "1710209952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42009 VICTORY LN",
"city": "LEESBURG",
"state": "VA",
"postal_code": "201766269",
"telephone_number": "330-758-4515",
"fax_number": "330-758-2862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42009 VICTORY LN",
"city": "LEESBURG",
"state": "VA",
"postal_code": "201766269",
"telephone_number": "330-758-4515",
"fax_number": "330-758-2862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLMAN",
"first_name": "JACQUELYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-02-15",
"last_updated": "2010-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810004223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.