Healthcare Provider Details

I. General information

NPI: 1306350376
Provider Name (Legal Business Name): MS. SHEILA HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. SHEILA MOORE

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 S HAWKINS AVE
AKRON OH
44320-3902
US

IV. Provider business mailing address

PO BOX 8189
AKRON OH
44320-0189
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-5400
  • Fax: 330-869-8263
Mailing address:
  • Phone: 330-867-5400
  • Fax: 330-869-8263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number166539
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number161735
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: