MEDICARE: JESSICA HOLTON, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1164966966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA HOLTON, PLLC

Provider Business Mailing Address
First Line	:	740 GREENVILLE BLVD SE STE 400-208
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5135
Country	:	US
Telephone Number	:	252-987-3039
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 GREENVILLE BLVD SE STE 400-208
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5135
Country	:	US
Telephone Number	:	252-987-3039
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER / PRESIDENT
Name	:	JESSICA DENISE HOLTON
Credential	:	MSW, LCSW, LCAS
Telephone Number	:	252-987-3039

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	10/26/2022

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