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NPI Code Detail

MEDICARE: MR. WILLIE DOUGLAS HOLCOMB LCSW

MEDICARE: MR. WILLIE DOUGLAS HOLCOMB LCSW
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
11041C0700XClinical Social Worker15930FL

General Provider Information

NPI Number : 1770639544
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIE DOUGLAS HOLCOMB LCSW
Provider Business Mailing Address
First Line : 2500 QUANTUM LAKES DR STE 203
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33426-8323
Country : US
Telephone Number : 901-237-4969
Fax Number : 901-323-3640
Provider Business Practice Location Address
First Line : 2500 QUANTUM LAKES DR STE 203
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33426-8323
Country : US
Telephone Number : 901-237-4969
Fax Number : 561-853-2199
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2007
Last Update Date : 01/10/2020

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