Provider Demographics
NPI:1174216246
Name:HOLLEY-JOHNS, SANDRA DEE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DEE
Last Name:HOLLEY-JOHNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-0391
Mailing Address - Country:US
Mailing Address - Phone:301-323-5629
Mailing Address - Fax:240-318-2825
Practice Address - Street 1:5820 DIX ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6965
Practice Address - Country:US
Practice Address - Phone:301-323-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management