Provider Demographics
NPI:1427500347
Name:HOLMES, SHAVONDRA RENEE
Entity type:Individual
Prefix:MISS
First Name:SHAVONDRA
Middle Name:RENEE
Last Name:HOLMES
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 1:730 N OLD COACHMAN RD APT C8
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2325
Mailing Address - Country:US
Mailing Address - Phone:918-640-8291
Mailing Address - Fax:
Practice Address - Street 1:730 N OLD COACHMAN RD APT C8
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2325
Practice Address - Country:US
Practice Address - Phone:918-640-8291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker