Provider Demographics
NPI:1386854149
Name:HOLCOMB, EDNA MARION
Entity Type:Individual
Prefix:MS
First Name:EDNA
Middle Name:MARION
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EDNA
Other - Middle Name:
Other - Last Name:DOWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6146 CAMINO VERDE DR
Mailing Address - Street 2:STE N4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1460
Mailing Address - Country:US
Mailing Address - Phone:408-847-2120
Mailing Address - Fax:408-842-8068
Practice Address - Street 1:6146 CAMINO VERDE DR
Practice Address - Street 2:STE N4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1460
Practice Address - Country:US
Practice Address - Phone:408-847-2120
Practice Address - Fax:408-842-8068
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMG14581106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist