Provider Demographics
NPI:1245466200
Name:HOLMAN, MICHELE JOEY (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:JOEY
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 N VILLA WOOD LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1588
Mailing Address - Country:US
Mailing Address - Phone:309-693-8200
Mailing Address - Fax:309-693-8207
Practice Address - Street 1:7617 N VILLA WOOD LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1588
Practice Address - Country:US
Practice Address - Phone:309-693-8200
Practice Address - Fax:309-693-8207
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0133311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical