Provider Demographics
NPI:1740982214
Name:HOLMES, JULISA (MS, LPC, MHC)
Entity type:Individual
Prefix:MRS
First Name:JULISA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MS, LPC, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 OAKWOOD DR APT 812
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-2386
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 WATERMAN ST STE 107
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4313
Practice Address - Country:US
Practice Address - Phone:617-315-8835
Practice Address - Fax:401-386-2543
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01629101YM0800X
PAPC014971101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health