Provider Demographics
NPI:1720202518
Name:HOLMES, WILLIE MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:MARIE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WHITAKER DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7723
Mailing Address - Country:US
Mailing Address - Phone:678-938-0033
Mailing Address - Fax:770-960-9664
Practice Address - Street 1:100 WHITAKER DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7723
Practice Address - Country:US
Practice Address - Phone:678-938-0033
Practice Address - Fax:770-960-9664
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker