Provider Demographics
NPI:1770639544
Name:HOLCOMB, WILLIE DOUGLAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:DOUGLAS
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 QUANTUM LAKES DR STE 203
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8323
Mailing Address - Country:US
Mailing Address - Phone:901-237-4969
Mailing Address - Fax:901-323-3640
Practice Address - Street 1:2500 QUANTUM LAKES DR STE 203
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8323
Practice Address - Country:US
Practice Address - Phone:901-237-4969
Practice Address - Fax:561-853-2199
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL159301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical