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General NPI Number Information
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NPI Number | 1992138176
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Entity Type | Individual
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Provider Name | KIANTE HOLMES
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Gender | Female
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 11936 NE SANDY BLVD
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City | PORTLAND
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State | OR
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Zip | 97220-1450
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Country | US
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Telephone | 503-206-7864
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Fax |
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Provider Business Mailing Address
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Address Line | 19814 NE HASSALO CT
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City | PORTLAND
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State | OR
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Zip | 97230-7969
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Country | US
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Telephone | 503-997-2659
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 545074
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | A4682
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License Number State | OR
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