Provider Demographics
NPI:1942458765
Name:HOLDER, LEA ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:LEA ANN
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 NE SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-2854
Mailing Address - Country:US
Mailing Address - Phone:360-281-3114
Mailing Address - Fax:844-400-6494
Practice Address - Street 1:1701 E EVERGREEN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4289
Practice Address - Country:US
Practice Address - Phone:360-281-3114
Practice Address - Fax:844-400-6494
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW607108961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical