Provider Demographics
NPI:1831304278
Name:HOLMBERG, SHIRLEY MAY (BA)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:MAY
Last Name:HOLMBERG
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 WOODRIVER
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709
Mailing Address - Country:US
Mailing Address - Phone:907-479-0673
Mailing Address - Fax:907-479-0683
Practice Address - Street 1:605 HUGHES AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7539
Practice Address - Country:US
Practice Address - Phone:907-479-0673
Practice Address - Fax:907-479-0683
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional