Provider Demographics
NPI:1497587034
Name:HOLMES, WILLIAM RUSSELL (LAC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:HOLMES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:W
Other - Middle Name:RUSS
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:2 LEVANT DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2658
Mailing Address - Country:US
Mailing Address - Phone:501-766-0254
Mailing Address - Fax:501-219-1943
Practice Address - Street 1:2 LEVANT DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2658
Practice Address - Country:US
Practice Address - Phone:501-766-0254
Practice Address - Fax:501-219-1943
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2408013101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor