Provider Demographics
NPI:1154541357
Name:HOLMES, KALANTE K (CCDC)
Entity type:Individual
Prefix:MR
First Name:KALANTE
Middle Name:K
Last Name:HOLMES
Suffix:
Gender:M
Credentials:CCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2872 CLARENDON AVE APT E
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4352
Mailing Address - Country:US
Mailing Address - Phone:323-793-7550
Mailing Address - Fax:
Practice Address - Street 1:11901 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2767
Practice Address - Country:US
Practice Address - Phone:310-268-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104224101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor