Provider Demographics
NPI:1124222419
Name:HOLDERIED, DANIEL JEROME (MA,LPC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JEROME
Last Name:HOLDERIED
Suffix:
Gender:M
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5008
Mailing Address - Country:US
Mailing Address - Phone:810-767-4014
Mailing Address - Fax:810-767-0020
Practice Address - Street 1:1422 W COURT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5008
Practice Address - Country:US
Practice Address - Phone:810-767-4014
Practice Address - Fax:810-767-0020
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005440101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional