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1457669079 NPI number — JESSICA BOLTON HOLT LPC

NPI Number: 1457669079
Health Care Provider/Practitioner: JESSICA BOLTON HOLT LPC

Information about “1457669079” NPI (JESSICA BOLTON HOLT LPC) exists in 1457669079 in HTML format HTML  |  1457669079 in plain Text format TXT  |  1457669079 in PDF (Portable Document Format) PDF  |  1457669079 in an XML format XML  formats.

NPI Number : 1457669079 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457669079",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HOLT",
    "FirstName": "JESSICA",
    "MiddleName": "BOLTON",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BAILEY",
    "OtherFirstName": "JESSICA",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "LPC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "160 ANDRIA WAY NW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CARTERSVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30120-2252",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "470-272-5116",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "160 ANDRIA WAY NW",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CARTERSVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30120-2252",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "470-272-5116",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/16/2010",
    "LastUpdateDate": "07/21/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YS0200X",
          "TaxonomyName": "School Counselor",
          "LicenseNumber": "1364633",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "LPC008249",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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