Doctor Name: | JACQUELINE HOLMES |
NPI Number: | 1740665462 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW, PIP |
License Number: | 1181-1921C |
Business Practice Address: | 121 Wilder Dr Harvest, AL - 357498270 |
Business Phone Number: | 2566534902 |
Business Fax Number: | |
Mailing Address: | 121 Wilder Dr, HARVEST |
State: | AL |
Postal Code: | 357498270 |
Phone Number: | 2566534902 |
Fax Number: | |
NPI Enumeration Date: | 07/23/2015 |
NPI Last Update Date: | 07/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 1181-1921C |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |