Healthcare Provider Details

I. General information

NPI: 1306886882
Provider Name (Legal Business Name): HOLCOMB ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 E MAIN ST
NEWARK DE
19711-7311
US

IV. Provider business mailing address

467 CREAMERY WAY
EXTON PA
19341-2508
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-1504
  • Fax: 302-731-2720
Mailing address:
  • Phone: 610-363-1488
  • Fax: 610-363-8273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateDE

VIII. Authorized Official

Name: TERESA JACKSON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 610-363-1488