Healthcare Provider Details

I. General information

NPI: 1376294686
Provider Name (Legal Business Name): EMILY HOLCOMB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SPRING ST STE 203
LA MESA CA
91942-0273
US

IV. Provider business mailing address

5638 LAKE MURRAY BLVD # 136
LA MESA CA
91942-1929
US

V. Phone/Fax

Practice location:
  • Phone: 619-549-0329
  • Fax:
Mailing address:
  • Phone: 858-324-4332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: