Provider Demographics
NPI:1437289550
Name:HOLMES, VIRGINIA (LCPC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3347
Mailing Address - Country:US
Mailing Address - Phone:207-667-6778
Mailing Address - Fax:
Practice Address - Street 1:58 NORTH ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3347
Practice Address - Country:US
Practice Address - Phone:207-667-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC 44101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME24Z037702ME01OtherANTHEM