Provider Demographics
NPI:1457669079
Name:HOLT, JESSICA BOLTON (LPC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:BOLTON
Last Name:HOLT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:160 ANDRIA WAY NW
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2252
Mailing Address - Country:US
Mailing Address - Phone:470-272-5116
Mailing Address - Fax:
Practice Address - Street 1:160 ANDRIA WAY NW
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2252
Practice Address - Country:US
Practice Address - Phone:470-272-5116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1364633101YS0200X
GALPC008249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool