Provider Demographics
NPI:1699363168
Name:HOLMES, KATELYN (MED, LAC, NCC)
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MED, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 RIDGEDALE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3074
Mailing Address - Country:US
Mailing Address - Phone:973-515-1216
Mailing Address - Fax:973-515-3108
Practice Address - Street 1:470 RIDGEDALE AVE STE 3
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3074
Practice Address - Country:US
Practice Address - Phone:973-515-1216
Practice Address - Fax:973-515-3108
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00555300101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37AC00555300OtherLICENSED ASSOCIATE COUNSELOR