Provider Demographics
NPI:1538193164
Name:HOLMES, DEIDRE MICHELLE
Entity type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:MICHELLE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 KEMPSEY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FUQUAY-VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526
Mailing Address - Country:US
Mailing Address - Phone:919-557-9435
Mailing Address - Fax:919-567-2751
Practice Address - Street 1:1508 KEMPSEY CIR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-7711
Practice Address - Country:US
Practice Address - Phone:919-557-9435
Practice Address - Fax:919-567-2751
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5159235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411710Medicaid