Provider Demographics
NPI:1487077814
Name:HOLLEMAN, LETICIA MARIE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:MARIE
Last Name:HOLLEMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14951 NW SEAVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEABECK
Mailing Address - State:WA
Mailing Address - Zip Code:98380-9755
Mailing Address - Country:US
Mailing Address - Phone:425-903-1119
Mailing Address - Fax:253-851-3188
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1703
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:253-851-3188
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60861543104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11908OtherVA MEDICAL CENTER