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General NPI Number Information
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NPI Number | 1427532324
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Entity Type | Individual
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Provider Name | MARY KATHLEEN HOLMES PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 8601 6 FORKS ROAD SUITE 400 #5013
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City | RALEIGH
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State | NC
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Zip | 27615
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Country | US
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Telephone | 804-404-6460
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Fax |
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Provider Business Mailing Address
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Address Line | 1249 KILDAIRE FARM RD STE 156
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City | CARY
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State | NC
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Zip | 27511-5523
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Country | US
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Telephone | 804-404-6460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810005925
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6079
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License Number State | NC
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