Individual
WILLETTA HOLMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2716 HIGH ST, PORTSMOUTH, VA 23707-3522
(914) 979-0810
Mailing address
2716 HIGH ST, PORTSMOUTH, VA 23707-3522
(914) 979-0810
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
CP575G
VA
Other
Enumeration date
02/15/2024
Last updated
02/15/2024
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