Provider Demographics
NPI:1427294834
Name:HOLLIMON, DIMIETRI ROSE
Entity type:Individual
Prefix:MRS
First Name:DIMIETRI
Middle Name:ROSE
Last Name:HOLLIMON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DIMIETRI
Other - Middle Name:ROSE
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2008 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2722
Mailing Address - Country:US
Mailing Address - Phone:909-623-6131
Mailing Address - Fax:
Practice Address - Street 1:2008 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2722
Practice Address - Country:US
Practice Address - Phone:909-623-6131
Practice Address - Fax:909-865-9281
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF65813106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist