Provider Demographics
NPI:1265582126
Name:HOLMES, RICHARD (MA CDP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MA CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 104TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6849
Mailing Address - Country:US
Mailing Address - Phone:425-455-4275
Mailing Address - Fax:
Practice Address - Street 1:1114 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4231
Practice Address - Country:US
Practice Address - Phone:425-258-5277
Practice Address - Fax:425-258-5275
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)