Provider Demographics
NPI:1639691520
Name:HOLMQUIST-BURKS, ANTHONY SCOTT (CAODC-A)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:SCOTT
Last Name:HOLMQUIST-BURKS
Suffix:
Gender:M
Credentials:CAODC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4335
Mailing Address - Country:US
Mailing Address - Phone:626-347-3719
Mailing Address - Fax:
Practice Address - Street 1:601 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4335
Practice Address - Country:US
Practice Address - Phone:626-347-3719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303472101YA0400X
CA85096104100000X
CA8402101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker