Provider Demographics
NPI:1457579971
Name:HOLMES, ANGELA (AOD COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:AOD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14623 HAWTHORNE BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1590
Mailing Address - Country:US
Mailing Address - Phone:310-973-0100
Mailing Address - Fax:910-973-0099
Practice Address - Street 1:14623 HAWTHORNE BLVD STE 306
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1590
Practice Address - Country:US
Practice Address - Phone:310-973-0100
Practice Address - Fax:910-973-0099
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAS REG. # 3174101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)