Provider Demographics
NPI:1972205631
Name:HOLMES, RONITTA L
Entity type:Individual
Prefix:
First Name:RONITTA
Middle Name:L
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 1:2211 FITZHUGH ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1243
Mailing Address - Country:US
Mailing Address - Phone:682-414-6402
Mailing Address - Fax:
Practice Address - Street 1:2211 FITZHUGH ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1243
Practice Address - Country:US
Practice Address - Phone:682-414-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health