Healthcare Provider Details

I. General information

NPI: 1336636562
Provider Name (Legal Business Name): MS. GULUNDA DENISE HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 E HAMILTON AVE
FLINT MI
48505-4707
US

IV. Provider business mailing address

765 E HAMILTON AVE
FLINT MI
48505-4707
US

V. Phone/Fax

Practice location:
  • Phone: 810-233-5340
  • Fax: 810-233-3565
Mailing address:
  • Phone: 810-233-5340
  • Fax: 810-233-3565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: