Provider Demographics
NPI:1033877543
Name:HOLDER, GIGI RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:GIGI
Middle Name:RENEE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GIGI
Other - Middle Name:R
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:504 CLINTON CENTER DRIVE
Mailing Address - Street 2:STE. 4300
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5610
Mailing Address - Country:US
Mailing Address - Phone:601-496-9413
Mailing Address - Fax:601-815-0434
Practice Address - Street 1:4400 OLD CANTON ROAD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211
Practice Address - Country:US
Practice Address - Phone:601-815-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC93951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical