Provider Demographics
NPI:1770690117
Name:HOLMES, REBECCA D (LICENSED PROFESSIONA)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:D
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2589
Mailing Address - Country:US
Mailing Address - Phone:276-525-1550
Mailing Address - Fax:276-525-1609
Practice Address - Street 1:610 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2589
Practice Address - Country:US
Practice Address - Phone:276-525-1550
Practice Address - Fax:276-525-1609
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710101825101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
289403OtherANTHEM BCBS
54097963215OtherJOHN DEERE HEALTHCARE
VA004945581Medicaid