Healthcare Provider Details

I. General information

NPI: 1194181081
Provider Name (Legal Business Name): BRUCE JUNIOR HOLMES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 W VIRGINIA AVE NE
WASHINGTON DC
20002-3817
US

IV. Provider business mailing address

1217 W VIRGINIA AVE NE
WASHINGTON DC
20002-3817
US

V. Phone/Fax

Practice location:
  • Phone: 202-397-1614
  • Fax: 202-398-4832
Mailing address:
  • Phone: 202-397-1614
  • Fax: 202-398-4832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: