Provider Demographics
NPI:1275150872
Name:CHRISTINE HOLMES, LICENSED CLINICAL SOCIAL WORKER INC.
Entity Type:Organization
Organization Name:CHRISTINE HOLMES, LICENSED CLINICAL SOCIAL WORKER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:951-444-1736
Mailing Address - Street 1:PO BOX 61830
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-6061
Mailing Address - Country:US
Mailing Address - Phone:951-444-1736
Mailing Address - Fax:
Practice Address - Street 1:1451 RIMPAU AVE STE 215
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-7522
Practice Address - Country:US
Practice Address - Phone:951-444-1736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty