Provider Demographics
NPI:1710612379
Name:HOLBROOK, SAMANTHA (CDCA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2676
Mailing Address - Country:US
Mailing Address - Phone:937-980-2790
Mailing Address - Fax:
Practice Address - Street 1:2131 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2676
Practice Address - Country:US
Practice Address - Phone:937-980-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)