Provider Demographics
NPI:1316427339
Name:HOLMAN, SAMANTHA BLAIR (LLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BLAIR
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MACOMB PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5625
Mailing Address - Country:US
Mailing Address - Phone:248-330-2434
Mailing Address - Fax:
Practice Address - Street 1:85 MACOMB PL
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5625
Practice Address - Country:US
Practice Address - Phone:248-509-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361002070103TC0700X, 103T00000X
103T00000X
MI6301017564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist