Provider Demographics
NPI:1720168966
Name:HOLMAN, MARIA TERESA (LCSW, LCAS-A)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:LCSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 LOCH GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7772
Mailing Address - Country:US
Mailing Address - Phone:704-960-3427
Mailing Address - Fax:
Practice Address - Street 1:1101 TYVOLA RD STE 218
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3515
Practice Address - Country:US
Practice Address - Phone:704-960-3427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20601101YA0400X
NCC0100321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)