Provider Demographics
NPI:1326887472
Name:HOLMAN, GRACIA
Entity type:Individual
Prefix:
First Name:GRACIA
Middle Name:
Last Name:HOLMAN
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 1:2209 ROSECRANS ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4949
Mailing Address - Country:US
Mailing Address - Phone:310-483-6383
Mailing Address - Fax:
Practice Address - Street 1:5266 HOLLISTER AVE STE 205
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-4040
Practice Address - Country:US
Practice Address - Phone:805-394-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT146496106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist