Provider Demographics
NPI:1285850073
Name:HOLBROOK, DUSTIN E (LISW, LICDC-CS)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:E
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:LISW, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 FLATWOOD FALLEN TIMBER RD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-9051
Mailing Address - Country:US
Mailing Address - Phone:740-352-8201
Mailing Address - Fax:
Practice Address - Street 1:624 9TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-429-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18010331041C0700X, 104100000X
OH021251101YA0400X
OH1600327104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker