Basic Information
| Provider Information | |||||||||
| NPI: | 1982740700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLT | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | JONES | ||||||||
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| Credential: | PHD, LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1070 BUCKLEY DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392066110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017132194 | ||||||||
| FaxNumber: | 6013668167 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 ORCHARD PARK | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391575135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019570727 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 1041C0700X | M2598 | MS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1356549083 | 01 | MS | NPI ON SITE THERAPY ASSOC | OTHER |