Provider Demographics
NPI:1730893967
Name:HOLMES, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
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 1:4949 E VAN BUREN ST UNIT 61024
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85026-9801
Mailing Address - Country:US
Mailing Address - Phone:602-448-8007
Mailing Address - Fax:855-330-6106
Practice Address - Street 1:3519 E SHEA BLVD STE 119A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3341
Practice Address - Country:US
Practice Address - Phone:602-448-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health