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NPI Code Detail

MEDICARE: SHANEKA HOLMES LCSW

MEDICARE: SHANEKA HOLMES LCSW
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
1101YA0400XAddiction (Substance Use Disorder) Counselor21999NC
21041C0700XClinical Social WorkerP008933NC
3227800000XCertified Respiratory TherapistA-3745NC
41041C0700XClinical Social Worker098724IA

Other Identifiers

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

General Provider Information

NPI Number : 1639302490
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANEKA HOLMES LCSW
Provider Business Mailing Address
First Line : PO BOX 970
Second Line :
City : HOPE MILLS
State : NC
Zip : 28348-0970
Country : US
Telephone Number : 910-286-3424
Fax Number :
Provider Business Practice Location Address
First Line : 401 ROBESON ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28301-5635
Country : US
Telephone Number : 910-286-3424
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2009
Last Update Date : 06/25/2020

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Directions to “ SHANEKA HOLMES LCSW” Practice Location

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