Basic Information
| Provider Information | |||||||||
| NPI: | 1801328935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLBROOK | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1167 SPRATLIN PARK DR | ||||||||
| Address2: | |||||||||
| City: | GRAY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376156205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234673600 | ||||||||
| FaxNumber: | 4234673644 | ||||||||
| Practice Location | |||||||||
| Address1: | 1006 US HIGHWAY 23 NORTH | ||||||||
| Address2: | |||||||||
| City: | WEBER CITY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242907021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762250976 | ||||||||
| FaxNumber: | 4234673644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2017 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0701006953 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.