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General NPI Number Information
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NPI Number | 1730651142
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Entity Type | Organization
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Legal Business Name | MARY T HOLCOMB PSYD LLC
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Dates
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Enumeration Date | 12/24/2018
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Last Update Date | 12/24/2018
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Provider Practice Location Address
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Address Line | 2700 WESTHALL LN STE 110
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City | MAITLAND
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State | FL
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Zip | 32751-7403
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Country | US
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Telephone | 407-475-1025
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Fax | 407-475-1027
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Provider Business Mailing Address
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Address Line | 914 KERSFIELD CIR
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City | LAKE MARY
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State | FL
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Zip | 32746-1936
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Country | US
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Telephone | 407-923-3927
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Fax |
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Authorized Official
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Title or Position | MARY T HOLCOMB
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Name | DR. MARY T HOLCOMB
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Credential | PSY.D.
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Telephone | 407-923-3927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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