Provider Demographics
NPI:1952544660
Name:HOLDER, MARJORY ESTELLE (MA, LPA)
Entity Type:Individual
Prefix:MS
First Name:MARJORY
Middle Name:ESTELLE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 FLANNERY FORK ROAD
Mailing Address - Street 2:
Mailing Address - City:BLOWING ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28605-9125
Mailing Address - Country:US
Mailing Address - Phone:828-265-0190
Mailing Address - Fax:828-262-3451
Practice Address - Street 1:895 STATE FARM RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4917
Practice Address - Country:US
Practice Address - Phone:828-265-0190
Practice Address - Fax:828-262-3451
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPA 2263103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist