Individual
DR. IMAC SORAYA REYNAGA HOLMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.D M.S. LPC LCADC
Contact information
Practice address
300 S 6TH ST, WILLIAMS, AZ 86046-0110
(928) 635-4441
(928) 635-4403
Mailing address
PO BOX 3630, FLAGSTAFF, AZ 86003-3630
(928) 522-9879
(928) 522-9880
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00163700
NJ
101YP2500X
Professional Counselor
37PC00398600
NJ
101YP2500X
Professional Counselor
Primary
LPC-19884
AZ
101YP2500X
Professional Counselor
PC004761
PA
Other
Enumeration date
12/18/2006
Last updated
07/21/2022
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