Healthcare Provider Details

I. General information

NPI: 1245504042
Provider Name (Legal Business Name): HOLLAND INITIATIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5779 GETWELL RD BLDG. D, SUITE 3
SOUTHAVEN MS
38672-6347
US

IV. Provider business mailing address

2951 RED BANKS RD N
BYHALIA MS
38611-7982
US

V. Phone/Fax

Practice location:
  • Phone: 662-510-6507
  • Fax: 662-510-6508
Mailing address:
  • Phone: 662-510-6507
  • Fax: 662-510-6508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1362
License Number StateMS

VIII. Authorized Official

Name: MRS. APRIL A HOLLAND
Title or Position: OWNER
Credential: LPC
Phone: 662-510-6507