Provider Demographics
NPI:1720574510
Name:HOLMES, ANNA-CATHERINE MARY (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:ANNA-CATHERINE
Middle Name:MARY
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:ANNA-CATHERINE
Other - Middle Name:MARY
Other - Last Name:SUSSMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:44225 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2638
Mailing Address - Country:US
Mailing Address - Phone:248-277-3005
Mailing Address - Fax:
Practice Address - Street 1:44225 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2638
Practice Address - Country:US
Practice Address - Phone:248-277-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-31128103K00000X
MI7401000151103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst