Provider Demographics
NPI:1659419067
Name:HOLMES, ALLEN WALTON (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:WALTON
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:OCCOQUAN
Mailing Address - State:VA
Mailing Address - Zip Code:22125-0057
Mailing Address - Country:US
Mailing Address - Phone:703-507-6866
Mailing Address - Fax:
Practice Address - Street 1:307A MAPLE AVE W # 2
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4305
Practice Address - Country:US
Practice Address - Phone:703-507-6866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002736103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist