Provider Demographics
NPI:1053478412
Name:HOLMES, DOROTHY E (PH D)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:E
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 20
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-5700
Mailing Address - Country:US
Mailing Address - Phone:202-966-7437
Mailing Address - Fax:202-496-6282
Practice Address - Street 1:4601 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 20
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-5700
Practice Address - Country:US
Practice Address - Phone:202-966-7437
Practice Address - Fax:202-496-6282
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC891103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC52-1644590OtherFEDERAL TAX I D NUMBER
DCG01672D01Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER