Healthcare Provider Details

I. General information

NPI: 1780187831
Provider Name (Legal Business Name): STEPHANIE L HOLMES MA/ EDS, LCMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LYNN WILCOX LCMHC, NCC

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TIMBERBROOK LN
GRANITE FALLS NC
28630-1976
US

IV. Provider business mailing address

510 CENTRAL ST # 142
HUDSON NC
28638-2401
US

V. Phone/Fax

Practice location:
  • Phone: 828-572-3880
  • Fax:
Mailing address:
  • Phone: 828-572-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: