Provider Demographics
NPI:1922536457
Name:HOLLAND, CONNIE ELIZABETH (MS, LPC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:ELIZABETH
Last Name:HOLLAND
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:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:ACKERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39735-0140
Mailing Address - Country:US
Mailing Address - Phone:662-489-1918
Mailing Address - Fax:662-796-4596
Practice Address - Street 1:168 JAILHOUSE RD
Practice Address - Street 2:
Practice Address - City:ACKERMAN
Practice Address - State:MS
Practice Address - Zip Code:39735
Practice Address - Country:US
Practice Address - Phone:662-489-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-29
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional