Provider Demographics
NPI:1790783868
Name:HOLCOMB, DAVID CARTER (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CARTER
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:SAN MIGUEL
Mailing Address - State:NM
Mailing Address - Zip Code:88058-0245
Mailing Address - Country:US
Mailing Address - Phone:575-522-5466
Mailing Address - Fax:575-521-8611
Practice Address - Street 1:255 W HADLEY AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1806
Practice Address - Country:US
Practice Address - Phone:575-268-2634
Practice Address - Fax:866-611-2571
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1056103TC0700X
NVPY0765103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM000650Medicaid