Provider Demographics
NPI:1316698970
Name:HOLMES, MARANDA LYNN (LPC)
Entity type:Individual
Prefix:
First Name:MARANDA
Middle Name:LYNN
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 GREYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2590
Mailing Address - Country:US
Mailing Address - Phone:404-805-9627
Mailing Address - Fax:
Practice Address - Street 1:140 GREYFIELD DR
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2590
Practice Address - Country:US
Practice Address - Phone:404-805-9627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor