Provider Demographics
NPI:1083206569
Name:HOLMES, LASHAUNDA NICOLE (LCSW-A)
Entity Type:Individual
Prefix:
First Name:LASHAUNDA
Middle Name:NICOLE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 ASHLEYBROOK LN STE 100
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2961
Mailing Address - Country:US
Mailing Address - Phone:336-774-2194
Mailing Address - Fax:
Practice Address - Street 1:1399 ASHLEYBROOK LN STE 100
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2961
Practice Address - Country:US
Practice Address - Phone:336-774-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-06
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0152931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical