Healthcare Provider Details

I. General information

NPI: 1720574510
Provider Name (Legal Business Name): ANNA-CATHERINE MARY HOLMES MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA-CATHERINE MARY SUSSMAN MA, BCBA

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44225 W 12 MILE RD
NOVI MI
48377-2638
US

IV. Provider business mailing address

44225 W 12 MILE RD
NOVI MI
48377-2638
US

V. Phone/Fax

Practice location:
  • Phone: 248-277-3005
  • Fax:
Mailing address:
  • Phone: 248-277-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31128
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401000151
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: