Healthcare Provider Details

I. General information

NPI: 1124749932
Provider Name (Legal Business Name): MS. MAKIRA HOLDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12611 BEECHFERN LN
BOWIE MD
20715-2438
US

IV. Provider business mailing address

12611 BEECHFERN LN
BOWIE MD
20715-2438
US

V. Phone/Fax

Practice location:
  • Phone: 301-318-4223
  • Fax:
Mailing address:
  • Phone: 301-318-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015870
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC200002269
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: