Provider Demographics
NPI:1407042518
Name:HOLDER, KARIS JOY BOYER (LPC)
Entity Type:Individual
Prefix:
First Name:KARIS
Middle Name:JOY BOYER
Last Name:HOLDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 GRANBY ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2607
Mailing Address - Country:US
Mailing Address - Phone:757-963-6303
Mailing Address - Fax:757-963-6074
Practice Address - Street 1:1216 GRANBY ST
Practice Address - Street 2:SUITE 213
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2607
Practice Address - Country:US
Practice Address - Phone:757-963-6303
Practice Address - Fax:757-963-6074
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1407042518Medicaid