Provider Demographics
NPI:1740652031
Name:HOLMES, MELINDA DESIREE (RSW)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:DESIREE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 JEFFERSON HWY APT 214
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2419
Mailing Address - Country:US
Mailing Address - Phone:504-782-4278
Mailing Address - Fax:
Practice Address - Street 1:8946 INTERLINE AVE STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1913
Practice Address - Country:US
Practice Address - Phone:225-205-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health