Provider Demographics
NPI:1912537317
Name:HOLLIE, COURTNEY M (P-LPC)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:M
Last Name:HOLLIE
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 MS-19
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301
Mailing Address - Country:US
Mailing Address - Phone:601-531-3200
Mailing Address - Fax:
Practice Address - Street 1:1054 MS-19
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-531-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0311101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor