Provider Demographics
NPI:1861649311
Name:HOLMES, DIANE C (LISW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:C
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2745
Mailing Address - Country:US
Mailing Address - Phone:319-277-4383
Mailing Address - Fax:319-268-2207
Practice Address - Street 1:324 W 3RD ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2745
Practice Address - Country:US
Practice Address - Phone:319-277-4383
Practice Address - Fax:319-268-2207
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA050901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074435Medicaid