Healthcare Provider Details

I. General information

NPI: 1669736062
Provider Name (Legal Business Name): NICOLE ANDREA HOLCOMB LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6804 LA ROCCA RD NW
ALBUQUERQUE NM
87114-3647
US

IV. Provider business mailing address

6804 LA ROCCA RD NW
ALBUQUERQUE NM
87114-3647
US

V. Phone/Fax

Practice location:
  • Phone: 505-358-5954
  • Fax:
Mailing address:
  • Phone: 505-358-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09079
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: