Provider Demographics
NPI:1093736498
Name:HOLMES, ANDREA
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 ENTERPRISE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1160
Mailing Address - Country:US
Mailing Address - Phone:727-365-8288
Mailing Address - Fax:727-796-2712
Practice Address - Street 1:2555 ENTERPRISE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1160
Practice Address - Country:US
Practice Address - Phone:727-365-8288
Practice Address - Fax:727-796-2712
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health