Provider Demographics
NPI:1720438641
Name:HOMES, NISSA HARRELL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NISSA
Middle Name:HARRELL
Last Name:HOMES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 SIERRA DR NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1661
Mailing Address - Country:US
Mailing Address - Phone:252-373-8231
Mailing Address - Fax:
Practice Address - Street 1:300 E ARLINGTON BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5024
Practice Address - Country:US
Practice Address - Phone:252-355-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist