Healthcare Provider Details

I. General information

NPI: 1528201951
Provider Name (Legal Business Name): CAROL A HOLMES LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ERIN CT
HILLSBORO OH
45133-8591
US

IV. Provider business mailing address

4449 STATE ROUTE 159 P.O. BOX 6179
CHILLICOTHEE OH
45601-8620
US

V. Phone/Fax

Practice location:
  • Phone: 937-393-9946
  • Fax: 937-393-2518
Mailing address:
  • Phone: 740-775-1260
  • Fax: 740-773-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0012681
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: