Provider Demographics
NPI:1194181081
Name:HOLMES, BRUCE JUNIOR
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:JUNIOR
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 W VIRGINIA AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3817
Mailing Address - Country:US
Mailing Address - Phone:202-397-1614
Mailing Address - Fax:202-398-4832
Practice Address - Street 1:1217 W VIRGINIA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3817
Practice Address - Country:US
Practice Address - Phone:202-397-1614
Practice Address - Fax:202-398-4832
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool