Provider Demographics
NPI:1215631064
Name:HOLNESS, SHAMICKA VICTORIA
Entity type:Individual
Prefix:
First Name:SHAMICKA
Middle Name:VICTORIA
Last Name:HOLNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 NEW MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-1410
Mailing Address - Country:US
Mailing Address - Phone:609-575-7520
Mailing Address - Fax:
Practice Address - Street 1:333 NEW MARKET ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-1410
Practice Address - Country:US
Practice Address - Phone:609-575-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician