Provider Demographics
NPI:1215952486
Name:HOLMES, SHAWNA MARIE (SST)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MARIE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:SST
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:MARIE
Other - Last Name:PAULLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SST
Mailing Address - Street 1:715 PYLE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802-4456
Mailing Address - Country:US
Mailing Address - Phone:906-774-0522
Mailing Address - Fax:906-774-1570
Practice Address - Street 1:715 PYLE DR
Practice Address - Street 2:
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802-4456
Practice Address - Country:US
Practice Address - Phone:906-774-0522
Practice Address - Fax:906-774-1570
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803085361104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker