MEDICARE: ROSELLE LOUISE HOLCOMBE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor	631604	GA
2	101YP2500X	Professional Counselor	3661	GA

General Provider Information

NPI Number	:	1730605288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSELLE LOUISE HOLCOMBE LPC

Provider Business Mailing Address
First Line	:	1592 PELHAM WAY
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-3849
Country	:	US
Telephone Number	:	478-952-3817
Fax Number	:

Provider Business Practice Location Address
First Line	:	329 MARGIE DR STE 1A
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-8981
Country	:	US
Telephone Number	:	478-352-0422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2017
Last Update Date	:	08/16/2017

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Directions to “ ROSELLE LOUISE HOLCOMBE LPC” Practice Location

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