Healthcare Provider Details

I. General information

NPI: 1700430790
Provider Name (Legal Business Name): MEREDITH JANE HOLMES ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2019
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 WILLOW PASS RD STE 101
CONCORD CA
94520-5225
US

IV. Provider business mailing address

4719 GEARY BLVD APT 608
SAN FRANCISCO CA
94118-2973
US

V. Phone/Fax

Practice location:
  • Phone: 925-825-1793
  • Fax:
Mailing address:
  • Phone: 917-238-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: