Provider Demographics
NPI:1073718284
Name:HOLM, CANDICE M (PSYD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:M
Last Name:HOLM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14150 PARKEAST CIR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2295
Mailing Address - Country:US
Mailing Address - Phone:703-968-4024
Mailing Address - Fax:703-263-1724
Practice Address - Street 1:14150 PARKEAST CIR
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2295
Practice Address - Country:US
Practice Address - Phone:703-968-4024
Practice Address - Fax:703-263-1724
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor