Provider Demographics
NPI:1447554332
Name:HOLMES, CONSTANCE L (EDD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:L
Last Name:HOLMES
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 MADISON AVE
Mailing Address - Street 2:SUITE 200D
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8080 MADISON AVE
Practice Address - Street 2:SUITE 200D
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3759
Practice Address - Country:US
Practice Address - Phone:916-616-8561
Practice Address - Fax:916-534-7753
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18209103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical