Healthcare Provider Details

I. General information

NPI: 1811931058
Provider Name (Legal Business Name): NOEL E HOLDSWORTH DNH, PMHNP-BC, CTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BLACK BEAR RIDGE BLACK BEAR TREATMENT CENTER
SAUTEE NACOOCHEE GA
30571
US

IV. Provider business mailing address

847 N LAKESHORE BLVD
LAKE WALES FL
33853-3821
US

V. Phone/Fax

Practice location:
  • Phone: 706-200-4021
  • Fax:
Mailing address:
  • Phone: 706-768-5787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number184767
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0050-03355
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP2596452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: