Basic Information
| Provider Information | |||||||||
| NPI: | 1457553000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLMES-KNIGHT | ||||||||
| FirstName: | ALLYSON | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2548 JACOBS ST | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945413384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104320422 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3301 E 12TH ST | ||||||||
| Address2: | SUITE 259 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946013424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102699121 | ||||||||
| FaxNumber: | 5102699031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 02/06/2017 | ||||||||
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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 | 103TC0700X | 27770 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | 27770 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | RU 38C72 | 01 | CA | MEDI-CAL | OTHER |