Provider Demographics
NPI:1003820614
Name:HOLMAN, EILEEN LOUISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:LOUISE
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 RIO SAN DIEGO DRIVE
Mailing Address - Street 2:VA MISSION VALLEY OUTPATIENT CLINIC
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-400-5243
Mailing Address - Fax:
Practice Address - Street 1:6586 AMBROSIA DRIVE
Practice Address - Street 2:#5204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124
Practice Address - Country:US
Practice Address - Phone:858-542-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical