Provider Demographics
NPI:1235612391
Name:HOLMES, NICKETA VESTERIA (RBT)
Entity Type:Individual
Prefix:
First Name:NICKETA
Middle Name:VESTERIA
Last Name:HOLMES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8184 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-3551
Mailing Address - Country:US
Mailing Address - Phone:571-316-6536
Mailing Address - Fax:
Practice Address - Street 1:7730 DONEGAN DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2868
Practice Address - Country:US
Practice Address - Phone:571-208-0592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-18-59210103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst