1770678625 NPI number — VICKI WARD HOLDEN LCSW

Table of content: VICKI WARD HOLDEN LCSW (NPI 1770678625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770678625 NPI number — VICKI WARD HOLDEN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLDEN
Provider First Name:
VICKI
Provider Middle Name:
WARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WARD
Provider Other First Name:
VICKI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770678625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 N NIMITZ
Provider Second Line Business Mailing Address:
SUITE C301
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-535-1708
Provider Business Mailing Address Fax Number:
808-845-7955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 N NIMITZ
Provider Second Line Business Practice Location Address:
SUITE C301
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-535-1708
Provider Business Practice Location Address Fax Number:
808-845-7955
Provider Enumeration Date:
10/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34005222A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 3755 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)