Provider Demographics
NPI:1588969299
Name:HOLM, EMILY EDWARDS (LPC, RPT)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:EDWARDS
Last Name:HOLM
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 MELROSE PL
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5309
Mailing Address - Country:US
Mailing Address - Phone:205-639-7221
Mailing Address - Fax:
Practice Address - Street 1:300 VESTAVIA PKWY
Practice Address - Street 2:SUITE 1000
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-7714
Practice Address - Country:US
Practice Address - Phone:205-639-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC#2897101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-44239OtherBLUE CROSS BLUE SHIELD