Provider Demographics
NPI:1184051062
Name:KELLY-HOLMES, THERESA (PHD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:KELLY-HOLMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MT OLIVET N.E.
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002
Mailing Address - Country:US
Mailing Address - Phone:301-343-7445
Mailing Address - Fax:
Practice Address - Street 1:1000 MOUNT OLIVET RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2210
Practice Address - Country:US
Practice Address - Phone:202-576-8125
Practice Address - Fax:202-576-9073
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-09
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist