Provider Demographics
NPI:1649922949
Name:HOLMES, RUBY JESSICA (LMHC)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:JESSICA
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 MEMORIAL CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5002
Mailing Address - Country:US
Mailing Address - Phone:138-694-4981
Mailing Address - Fax:
Practice Address - Street 1:570 MEMORIAL CIR STE 200
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5002
Practice Address - Country:US
Practice Address - Phone:138-694-4981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21978101YA0400X, 101YM0800X
FLIMH20808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)