Provider Demographics
NPI:1801348131
Name:HOLMES, NICOLE HEATHER DAWN (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:HEATHER DAWN
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 LAKE HARBIN RD UNIT 253
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-5207
Mailing Address - Country:US
Mailing Address - Phone:404-590-0338
Mailing Address - Fax:
Practice Address - Street 1:50 S STEELE ST SUITE 435
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209
Practice Address - Country:US
Practice Address - Phone:404-590-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional