Provider Demographics
NPI:1376094060
Name:HOLMES, ASHANTI
Entity Type:Individual
Prefix:
First Name:ASHANTI
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E ROGER RD
Mailing Address - Street 2:APT. G71
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1201
Mailing Address - Country:US
Mailing Address - Phone:484-632-1630
Mailing Address - Fax:
Practice Address - Street 1:2000 E ROGER RD
Practice Address - Street 2:APT. G71
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1201
Practice Address - Country:US
Practice Address - Phone:484-632-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician