Provider Demographics
NPI:1114639515
Name:HOLMES, CHRISTOPHER ISAAC
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ISAAC
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10555 MONTGOMERY BLVD NE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3857
Mailing Address - Country:US
Mailing Address - Phone:505-503-7946
Mailing Address - Fax:505-503-7947
Practice Address - Street 1:10555 MONTGOMERY BLVD NE BLDG 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3857
Practice Address - Country:US
Practice Address - Phone:505-503-7946
Practice Address - Fax:505-503-7947
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-03611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical