Provider Demographics
NPI:1770810764
Name:HOLTON, DESHISHA R (LCSW)
Entity type:Individual
Prefix:MS
First Name:DESHISHA
Middle Name:R
Last Name:HOLTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DEE
Other - Middle Name:R
Other - Last Name:HOLTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 24722
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33802-4722
Mailing Address - Country:US
Mailing Address - Phone:813-402-8780
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 24722
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33802-4722
Practice Address - Country:US
Practice Address - Phone:813-402-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1267721041C0700X
FLSW 77561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical