Provider Demographics
NPI:1255221891
Name:HOLM, PETER JOHN (LCSW, CSAC)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOHN
Last Name:HOLM
Suffix:
Gender:M
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 CAMPBELL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-3534
Mailing Address - Country:US
Mailing Address - Phone:540-580-7868
Mailing Address - Fax:540-400-8177
Practice Address - Street 1:706 CAMPBELL AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-3534
Practice Address - Country:US
Practice Address - Phone:540-580-7868
Practice Address - Fax:540-400-8177
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040151931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical