Provider Demographics
NPI:1275901217
Name:HOLMES, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
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 1:777 W HARRISBURG PIKE
Mailing Address - Street 2:PENN STATE HARRISBURG STUDENT ENRICHMENT CTR, SUITE 205
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-4846
Mailing Address - Country:US
Mailing Address - Phone:717-948-6025
Mailing Address - Fax:
Practice Address - Street 1:777 W HARRISBURG PIKE
Practice Address - Street 2:PENN STATE HARRISBURG STUDENT ENRICHMENT CTR, SUITE 205
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-4846
Practice Address - Country:US
Practice Address - Phone:717-948-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional