Provider Demographics
NPI:1699900647
Name:HOLBERT, CORDELIA M (PHD)
Entity type:Individual
Prefix:DR
First Name:CORDELIA
Middle Name:M
Last Name:HOLBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3852 SOUTH DESERT AIR BLVD
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-8368
Mailing Address - Country:US
Mailing Address - Phone:928-750-8869
Mailing Address - Fax:
Practice Address - Street 1:3852 SOUTH DESERT AIR BLVD
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-8368
Practice Address - Country:US
Practice Address - Phone:928-750-8869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD147621041C0700X
KS21961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical