Provider Demographics
NPI:1972032449
Name:HOLMES, NACOLE MARIETTA (COUNSELOR CERTIFIED)
Entity Type:Individual
Prefix:
First Name:NACOLE
Middle Name:MARIETTA
Last Name:HOLMES
Suffix:
Gender:F
Credentials:COUNSELOR CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2509
Mailing Address - Country:US
Mailing Address - Phone:360-998-2349
Mailing Address - Fax:360-998-2887
Practice Address - Street 1:831 12TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2403
Practice Address - Country:US
Practice Address - Phone:360-998-2349
Practice Address - Fax:360-998-2887
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61103201101YM0800X, 104100000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker