Provider Demographics
NPI:1376069963
Name:HOLMAN, ADAM G (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:G
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 S POWER RD APT 1003
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-6482
Mailing Address - Country:US
Mailing Address - Phone:262-365-7762
Mailing Address - Fax:
Practice Address - Street 1:6151 S POWER RD APT 1003
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-6482
Practice Address - Country:US
Practice Address - Phone:928-851-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9153-1231041C0700X
WI1306731041C0700X
AZLCSW-195001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical