Provider Demographics
NPI:1356758155
Name:HOLMES, COURTNEY FIELDS (LCSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:FIELDS
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4301
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-4301
Mailing Address - Country:US
Mailing Address - Phone:912-656-6212
Mailing Address - Fax:
Practice Address - Street 1:207 S COLUMBIA AVE STE C
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9027
Practice Address - Country:US
Practice Address - Phone:912-656-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0051791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical