| Doctor Name: | MR. VERNON ALBERT HOLM |
| NPI Number: | 1235441510 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 1367 |
| Business Practice Address: | 323 W 2nd St San Dimas, CA - 917732029 |
| Business Phone Number: | 9099198081 |
| Business Fax Number: | 9095926897 |
| Mailing Address: | 323 W 2nd St, SAN DIMAS |
| State: | CA |
| Postal Code: | 917732029 |
| Phone Number: | 9099198081 |
| Fax Number: | 9095926897 |
| NPI Enumeration Date: | 07/02/2010 |
| NPI Last Update Date: | 07/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1367 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |