Provider Demographics
NPI:1194566158
Name:HOLMES, FLORENCE O (MS)
Entity type:Individual
Prefix:MRS
First Name:FLORENCE
Middle Name:O
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:FLORENCE
Other - Middle Name:O
Other - Last Name:CHUKWUDEBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 DELAWARE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-1209
Mailing Address - Country:US
Mailing Address - Phone:217-502-8800
Mailing Address - Fax:
Practice Address - Street 1:2401 DELAWARE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-1209
Practice Address - Country:US
Practice Address - Phone:217-502-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health