Provider Demographics
NPI:1689774937
Name:HOLMBERG, SHARON B (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:B
Last Name:HOLMBERG
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 1:280 MATTINGLY RD
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-7689
Mailing Address - Country:US
Mailing Address - Phone:601-529-8913
Mailing Address - Fax:601-661-8457
Practice Address - Street 1:280 MATTINGLY RD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-7689
Practice Address - Country:US
Practice Address - Phone:601-529-8913
Practice Address - Fax:601-661-8457
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC53901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05475070Medicaid