Healthcare Provider Details

I. General information

NPI: 1932087954
Provider Name (Legal Business Name): DIONNE RIVERS HOLLIDAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 ERNEST LN
LINDEN NC
28356-8537
US

IV. Provider business mailing address

165 ERNEST LN
LINDEN NC
28356-8537
US

V. Phone/Fax

Practice location:
  • Phone: 919-587-9593
  • Fax:
Mailing address:
  • Phone: 919-587-9593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: