MEDICARE: DR. DONITA PATRICIA HOLMES LISW-CP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist
2	1041C0700X	Clinical Social Worker	C005480	NC
3	1041C0700X	Clinical Social Worker	8780	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295778728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONITA PATRICIA HOLMES LISW-CP

Provider Business Mailing Address
First Line	:	737 SAWGRASS RIDGE CT
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-7009
Country	:	US
Telephone Number	:	803-207-0993
Fax Number	:	866-591-1741

Provider Business Practice Location Address
First Line	:	737 SAWGRASS RIDGE CT
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-7009
Country	:	US
Telephone Number	:	803-207-0993
Fax Number	:	866-591-1741

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	05/22/2025

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Directions to “ DR. DONITA PATRICIA HOLMES LISW-CP” Practice Location

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