Provider Demographics
NPI:1336303478
Name:HOLMES, LOLA CHRISTINE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:LOLA
Middle Name:CHRISTINE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 PARK ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5500
Mailing Address - Country:US
Mailing Address - Phone:510-644-4219
Mailing Address - Fax:510-521-8253
Practice Address - Street 1:1242 PARK ST
Practice Address - Street 2:SUITE C
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5500
Practice Address - Country:US
Practice Address - Phone:510-644-4219
Practice Address - Fax:510-521-8253
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist