Healthcare Provider Details

I. General information

NPI: 1730605288
Provider Name (Legal Business Name): ROSELLE LOUISE HOLCOMBE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 MARGIE DR STE 1A
WARNER ROBINS GA
31088-8981
US

IV. Provider business mailing address

1592 PELHAM WAY
MACON GA
31220-3849
US

V. Phone/Fax

Practice location:
  • Phone: 478-352-0422
  • Fax:
Mailing address:
  • Phone: 478-952-3817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3661
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number631604
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: