Healthcare Provider Details

I. General information

NPI: 1710688007
Provider Name (Legal Business Name): JADA ANNETTE HOLIFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SUPERIOR DR
SPRING LAKE NC
28390-3190
US

IV. Provider business mailing address

1477 NC 24-87
CAMERON NC
28326-6752
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-1711
  • Fax:
Mailing address:
  • Phone: 910-497-0073
  • Fax: 919-869-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-469193
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberABAT-13442
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: