Basic Information
Provider Information | |||||||||
NPI: | 1174030266 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOLCMAN | ||||||||
FirstName: | NICHOLAS | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1791 ALUM CREEK DR | ||||||||
Address2: |   | ||||||||
City: | COLUMBUS | ||||||||
State: | OH | ||||||||
PostalCode: | 432071757 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6144458131 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 715 S PLUM ST | ||||||||
Address2: |   | ||||||||
City: | MARYSVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 430401631 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9376449192 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/10/2018 | ||||||||
LastUpdateDate: | 08/18/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/18/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6802089656 | MI | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 171M00000X |   | OH | Y |   | Other Service Providers | Case Manager/Care Coordinator |   | 1041C0700X | 000566635 | OH | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.