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General NPI Number Information
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NPI Number | 1417195546
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Entity Type | Individual
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Provider Name | VIRGINIA ELIZABETH HOLM LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 501 GLOUCESTER ST STE 115
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City | BRUNSWICK
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State | GA
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Zip | 31520-7030
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Country | US
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Telephone | 125-808-5679
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Fax | 770-339-7667
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Provider Business Mailing Address
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Address Line | PO BOX 3236
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City | BRUNSWICK
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State | GA
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Zip | 31521-3236
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Country | US
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Telephone | 129-580-8567
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Fax | 770-995-1959
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003987
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License Number State | GA
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