Provider Demographics
NPI:1831312784
Name:HOLMES, DIANA KATHLEEN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:KATHLEEN
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5057 NARRAGANSETT AVE
Mailing Address - Street 2:APT #17
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5057 NARRAGANSETT AVE
Practice Address - Street 2:APT #17
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3022
Practice Address - Country:US
Practice Address - Phone:619-222-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 190191041C0700X
MA1156811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical