Healthcare Provider Details

I. General information

NPI: 1104265727
Provider Name (Legal Business Name): HOLLY MARIE ADEMA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 GOVERNORS LN STE C
CHICO CA
95926-5514
US

IV. Provider business mailing address

PO BOX 4751
CHICO CA
95927-4751
US

V. Phone/Fax

Practice location:
  • Phone: 530-433-9355
  • Fax:
Mailing address:
  • Phone: 707-481-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number76476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: