Provider Demographics
NPI:1417195546
Name:HOLM, VIRGINIA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ELIZABETH
Last Name:HOLM
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 1:1421 LEE ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-7132
Mailing Address - Country:US
Mailing Address - Phone:912-265-0007
Mailing Address - Fax:912-261-0593
Practice Address - Street 1:1421 LEE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-7132
Practice Address - Country:US
Practice Address - Phone:912-265-0007
Practice Address - Fax:912-261-0593
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0039871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical