Healthcare Provider Details

I. General information

NPI: 1396660064
Provider Name (Legal Business Name): AVAYA HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12120 PLUM ORCHARD DR STE 145
SILVER SPRING MD
20904-7801
US

IV. Provider business mailing address

12120 PLUM ORCHARD DR STE 145
SILVER SPRING MD
20904-7801
US

V. Phone/Fax

Practice location:
  • Phone: 855-782-7822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: