Provider Demographics
NPI:1265623474
Name:HOLDER, DONNAREAKICA TONETTE
Entity type:Individual
Prefix:
First Name:DONNAREAKICA
Middle Name:TONETTE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-3615
Mailing Address - Country:US
Mailing Address - Phone:561-562-2314
Mailing Address - Fax:
Practice Address - Street 1:210 LIBERTY HILL RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2442
Practice Address - Country:US
Practice Address - Phone:910-272-9056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14458235Z00000X
235Z00000X
FLSA16940235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist