Provider Demographics
NPI:1144427691
Name:HOLMES, JANNAN W (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANNAN
Middle Name:W
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 WESTWOOD OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5121
Mailing Address - Country:US
Mailing Address - Phone:540-370-4596
Mailing Address - Fax:540-370-0399
Practice Address - Street 1:810 WESTWOOD OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5121
Practice Address - Country:US
Practice Address - Phone:540-370-4596
Practice Address - Fax:540-370-0399
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040037191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical