Provider Demographics
NPI:1699448084
Name:MARIA HOLM LICENSED CLINICAL SOCIAL WORKER INC
Entity type:Organization
Organization Name:MARIA HOLM LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-371-5522
Mailing Address - Street 1:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93556-0955
Mailing Address - Country:US
Mailing Address - Phone:760-371-5522
Mailing Address - Fax:
Practice Address - Street 1:751 S RICHMOND RD STE D
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-8217
Practice Address - Country:US
Practice Address - Phone:909-932-1069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty