Provider Demographics
NPI:1861427452
Name:HOLM, THOMAS A (PHD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:HOLM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 BETHESDA PL
Mailing Address - Street 2:SUITE 604-B
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3318
Mailing Address - Country:US
Mailing Address - Phone:336-659-8087
Mailing Address - Fax:336-659-8194
Practice Address - Street 1:2990 BETHESDA PL
Practice Address - Street 2:SUITE 604-B
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3318
Practice Address - Country:US
Practice Address - Phone:336-659-8087
Practice Address - Fax:336-659-8194
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC682103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000482Medicaid
NC279057OtherVALUE OPTIONS
NC6115017OtherUNITED BEHAVIORAL HEALTH
NC03140OtherBLUE CROSS BLUE SHEILD
NC03140OtherBLUE CROSS BLUE SHEILD
NC6115017OtherUNITED BEHAVIORAL HEALTH