Healthcare Provider Details

I. General information

NPI: 1821904368
Provider Name (Legal Business Name): MARK FRANCIS HOULDIN
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: EMERY HOULDIN

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 LYCKAN PKWY STE 205
DURHAM NC
27707-2586
US

IV. Provider business mailing address

1011 CHESTER ST
DURHAM NC
27701-3815
US

V. Phone/Fax

Practice location:
  • Phone: 919-514-3655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024421
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: