Provider Demographics
NPI:1780727909
Name:HOLTON, JESSICA DENISE (MSW, LCSW, LCAS)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DENISE
Last Name:HOLTON
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 GREENVILLE BLVD SE STE 400-208
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5135
Mailing Address - Country:US
Mailing Address - Phone:252-987-3039
Mailing Address - Fax:
Practice Address - Street 1:740 GREENVILLE BLVD SE STE 400-208
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5135
Practice Address - Country:US
Practice Address - Phone:252-987-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0051871041C0700X
NC963101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC447992OtherTRICARE PIN
11612221OtherCAQH UNIVERSAL DATA SOURC
NC56162OtherMEDCOST
NC1780727909Medicaid
NC142CHOtherBLUECROSS BLUESHIELD
NC142CHOtherBLUECROSS BLUESHIELD
NCQ49696AMedicare PIN