Provider Demographics
NPI:1689183485
Name:HOLTON, SYREETA D (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:SYREETA
Middle Name:D
Last Name:HOLTON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7409
Mailing Address - Country:US
Mailing Address - Phone:804-306-6605
Mailing Address - Fax:
Practice Address - Street 1:502 N 30TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7409
Practice Address - Country:US
Practice Address - Phone:804-306-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-14578174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
174N00000XOtherN/A