Healthcare Provider Details

I. General information

NPI: 1457876476
Provider Name (Legal Business Name): CELINA JO HOLGUIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WYATT DR
LAS CRUCES NM
88005-2925
US

IV. Provider business mailing address

4779 KERRY ANN PL
LAS CRUCES NM
88012-7474
US

V. Phone/Fax

Practice location:
  • Phone: 575-652-3155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-11742
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0894
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: