Healthcare Provider Details

I. General information

NPI: 1689501611
Provider Name (Legal Business Name): ALAINA HOLDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 ENGLE RD STE 305
FORT WAYNE IN
46804-2227
US

IV. Provider business mailing address

4625 ANGLERS LN
FORT WAYNE IN
46808-3508
US

V. Phone/Fax

Practice location:
  • Phone: 260-203-4996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39006002A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: