Provider Demographics
NPI:1821382623
Name:HOLMES, LYDIA D
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:D
Last Name:HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LYDIA
Other - Middle Name:D
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LYDIA HOLMES-MCQUEEN
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:GENESEE
Mailing Address - State:MI
Mailing Address - Zip Code:48437-0089
Mailing Address - Country:US
Mailing Address - Phone:810-336-1971
Mailing Address - Fax:
Practice Address - Street 1:303 W WATER ST
Practice Address - Street 2:SUITE 108
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5627
Practice Address - Country:US
Practice Address - Phone:810-232-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011146201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical