Provider Demographics
NPI:1861023509
Name:HOLM, BENJAMIN SAMUEL (LMSW, CAADC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SAMUEL
Last Name:HOLM
Suffix:
Gender:M
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 CARROLLTON RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2306
Mailing Address - Country:US
Mailing Address - Phone:989-295-1891
Mailing Address - Fax:
Practice Address - Street 1:4570 MACKINAW RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2101
Practice Address - Country:US
Practice Address - Phone:989-295-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011136941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical