Provider Demographics
NPI:1811765977
Name:HOLYFIELD, JUDY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:HOLYFIELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:GARCIA
Other - Last Name:ADVIENTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:950 KAMEHAMEHA HWY
Mailing Address - Street 2:#19
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782
Mailing Address - Country:US
Mailing Address - Phone:808-277-4413
Mailing Address - Fax:
Practice Address - Street 1:950 KAMEHAMEHA HWY
Practice Address - Street 2:#19
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782
Practice Address - Country:US
Practice Address - Phone:808-277-4413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-47841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical