Provider Demographics
NPI:1336979061
Name:HOLDBROOKS, AMY LEA (LPC05312)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEA
Last Name:HOLDBROOKS
Suffix:
Gender:F
Credentials:LPC05312
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 BANK ST NE STE E
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-1606
Mailing Address - Country:US
Mailing Address - Phone:256-309-7571
Mailing Address - Fax:
Practice Address - Street 1:502 BANK ST NE STE E
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-1606
Practice Address - Country:US
Practice Address - Phone:256-309-7571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC05312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional