=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114531191
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAMMY HOLCOMB, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2020
-----------------------------------------------------
Last Update Date | 09/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5001 S MIAMI BLVD STE 325
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27703-8526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-909-7959
-----------------------------------------------------
Fax | 919-246-9390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5001 S MIAMI BLVD STE 325
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27703-8526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-909-7959
-----------------------------------------------------
Fax | 919-246-9390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | TAMMY HELEN HOLCOMB
-----------------------------------------------------
Credential | LCMHCS
-----------------------------------------------------
Telephone | 919-909-7959
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------