Basic Information
| Provider Information | |||||||||
| NPI: | 1376757385 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | MONICA | ||||||||
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| Credential: | RASI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 LANCASTER CIR APT 245 | ||||||||
| Address2: | |||||||||
| City: | BAY POINT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945656661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108600516 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1266 14TH ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946072205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105313111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 12/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | RI-H0604200922 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.