Provider Demographics
NPI:1861933186
Name:HOLLEY-BRAMBLETT, EILEEN MELINDA
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MELINDA
Last Name:HOLLEY-BRAMBLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:MELINDA
Other - Last Name:HOLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HAMPTON VA MEDICAL CTR
Mailing Address - Street 2:100 EMANCIPATION DRIVE
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23667-0001
Mailing Address - Country:US
Mailing Address - Phone:757-663-1084
Mailing Address - Fax:
Practice Address - Street 1:HAMPTON VA MEDICAL CTR
Practice Address - Street 2:100 EMANCIPATION DRIVE
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-0001
Practice Address - Country:US
Practice Address - Phone:757-663-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096098-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker