Provider Demographics
NPI:1912161936
Name:HOLMES, DAVID JASON (LMSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JASON
Last Name:HOLMES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6927
Mailing Address - Country:US
Mailing Address - Phone:505-325-1877
Mailing Address - Fax:
Practice Address - Street 1:925 CANNERY CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4058
Practice Address - Country:US
Practice Address - Phone:505-327-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-06546104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker