Provider Demographics
NPI:1093270613
Name:RAKESTRAW, HOLLY SMITH (LPC, NCC, NCSC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:SMITH
Last Name:RAKESTRAW
Suffix:
Gender:F
Credentials:LPC, NCC, NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MEGS LN
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-7940
Mailing Address - Country:US
Mailing Address - Phone:662-213-4676
Mailing Address - Fax:
Practice Address - Street 1:813 VARSITY DR STE 5
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4694
Practice Address - Country:US
Practice Address - Phone:662-840-2005
Practice Address - Fax:662-840-2107
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional