Healthcare Provider Details

I. General information

NPI: 1396977070
Provider Name (Legal Business Name): ESTINA M HOLDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHICKASAW DR
HATTIESBURG MS
39401-2852
US

IV. Provider business mailing address

100 CHICKASAW DR
HATTIESBURG MS
39401-2852
US

V. Phone/Fax

Practice location:
  • Phone: 601-705-1901
  • Fax:
Mailing address:
  • Phone: 601-705-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2889
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0795
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2889
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: