Provider Demographics
NPI:1972701266
Name:LINDA HOLCOMB,MSW, INC
Entity type:Organization
Organization Name:LINDA HOLCOMB,MSW, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:605-341-8647
Mailing Address - Street 1:3601 CANYON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3900
Mailing Address - Country:US
Mailing Address - Phone:605-341-8647
Mailing Address - Fax:605-341-0489
Practice Address - Street 1:3601 CANYON LAKE DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3900
Practice Address - Country:US
Practice Address - Phone:605-341-8647
Practice Address - Fax:605-341-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-07
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCSW-PIP 9461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0004392OtherBLUE CROSS/BLUE SHIELD
SD6570532Medicaid
SD0004392OtherBLUE CROSS/BLUE SHIELD