Provider Demographics
NPI:1497890305
Name:HOLMES, RHONDA (LCSW)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 FRIDAY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9641
Mailing Address - Country:US
Mailing Address - Phone:910-470-0893
Mailing Address - Fax:
Practice Address - Street 1:4900 RANDALL PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1798
Practice Address - Country:US
Practice Address - Phone:910-795-9258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0038051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003472Medicaid
NC1292YOtherBCBS