Provider Demographics
NPI:1164084018
Name:HOLMES, SANDRA (MS, CSAC, LPC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MS, CSAC, LPC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:SKYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 WESTHILL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3795
Mailing Address - Country:US
Mailing Address - Phone:715-847-2772
Mailing Address - Fax:715-847-2928
Practice Address - Street 1:420 DEWEY ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4714
Practice Address - Country:US
Practice Address - Phone:715-847-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2061-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional