Provider Demographics
NPI:1306892641
Name:HOLMES, MARY (ST)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1404
Mailing Address - Country:US
Mailing Address - Phone:919-781-5728
Mailing Address - Fax:919-781-5744
Practice Address - Street 1:2316 ANDERSON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-1404
Practice Address - Country:US
Practice Address - Phone:919-781-5728
Practice Address - Fax:919-781-5744
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12431OtherBCBS
NC7411565Medicaid