Provider Demographics
NPI:1720665904
Name:HOLLAND, DOMINIQUE JESSICA
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:JESSICA
Last Name:HOLLAND
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 1:3529 RIO ROBLES DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-4659
Mailing Address - Country:US
Mailing Address - Phone:725-200-8936
Mailing Address - Fax:
Practice Address - Street 1:9031 W LA MADRE WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3536
Practice Address - Country:US
Practice Address - Phone:702-684-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker