Provider Demographics
NPI:1043286487
Name:HOLLAND, JERALD CRAIG (MED, LMHC)
Entity Type:Individual
Prefix:MR
First Name:JERALD
Middle Name:CRAIG
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 916
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-0916
Mailing Address - Country:US
Mailing Address - Phone:904-753-1563
Mailing Address - Fax:904-491-0478
Practice Address - Street 1:501 CENTRE ST
Practice Address - Street 2:SUITE 117
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3936
Practice Address - Country:US
Practice Address - Phone:904-753-1563
Practice Address - Fax:904-491-0477
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5407101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health