Healthcare Provider Details

I. General information

NPI: 1740609437
Provider Name (Legal Business Name): ANTHONY HOLMES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANTHONY HOLMES LGSW

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 FALLSWAY
BALTIMORE MD
21202-4800
US

IV. Provider business mailing address

421 FALLSWAY
BALTIMORE MD
21202-4800
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-5533
  • Fax:
Mailing address:
  • Phone: 410-837-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14391
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14391
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14391
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: