Provider Demographics
NPI:1306219258
Name:HOLMES, OLIVE A (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:OLIVE
Middle Name:A
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:OLIVE
Other - Middle Name:A
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 WILLOW PL
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4459
Mailing Address - Country:US
Mailing Address - Phone:970-799-7780
Mailing Address - Fax:
Practice Address - Street 1:281 SAWYER DR
Practice Address - Street 2:#100
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-3409
Practice Address - Country:US
Practice Address - Phone:970-259-2162
Practice Address - Fax:970-247-5255
Is Sole Proprietor?:No
Enumeration Date:2015-10-31
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099241041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical