Provider Demographics
NPI:1831303049
Name:HOLMQUIST, LARRY JAMES (LADC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:JAMES
Last Name:HOLMQUIST
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 P ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3528
Mailing Address - Country:US
Mailing Address - Phone:402-475-7315
Mailing Address - Fax:402-475-8721
Practice Address - Street 1:2220 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3445
Practice Address - Country:US
Practice Address - Phone:402-475-7315
Practice Address - Fax:402-475-8721
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE311101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)