Provider Demographics
NPI:1659428399
Name:HOLDER, LINDA MOORE (MS LPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MOORE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 MAGNOLIA ST
Mailing Address - Street 2:SUITE 303/305
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-4168
Mailing Address - Country:US
Mailing Address - Phone:228-762-3102
Mailing Address - Fax:228-762-3166
Practice Address - Street 1:3207 MAGNOLIA ST
Practice Address - Street 2:SUITE 303/305
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-4168
Practice Address - Country:US
Practice Address - Phone:228-762-3102
Practice Address - Fax:228-762-3166
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0195101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional