Healthcare Provider Details

I. General information

NPI: 1033069695
Provider Name (Legal Business Name): NAKIA HOLTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3794 MS-468
PEARL MS
39208
US

IV. Provider business mailing address

340 ARBOR DR APT 191
RIDGELAND MS
39157-4846
US

V. Phone/Fax

Practice location:
  • Phone: 662-205-6772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3392
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: