Provider Demographics
NPI:1306667977
Name:HOLMQUIST, MICHAEL RAY (LCSW-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAY
Last Name:HOLMQUIST
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12319 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2957
Mailing Address - Country:US
Mailing Address - Phone:719-354-9131
Mailing Address - Fax:
Practice Address - Street 1:8380 COLESVILLE RD STE 300
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-6264
Practice Address - Country:US
Practice Address - Phone:719-354-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD289501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical