Provider Demographics
NPI:1538404850
Name:HOLMES, JACQUELINE CHERISE (MSHS)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:CHERISE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505-3995
Mailing Address - Country:US
Mailing Address - Phone:810-691-3343
Mailing Address - Fax:
Practice Address - Street 1:4119 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-3995
Practice Address - Country:US
Practice Address - Phone:810-691-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health