MEDICARE: ESTINA M HOLDER LPC

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	101YM0800X	Mental Health Counselor	2889	MS
2	101YM0800X	Mental Health Counselor	0795	MS
3	101YP2500X	Professional Counselor	2889	MS

General Provider Information

NPI Number	:	1396977070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTINA M HOLDER LPC

Provider Business Mailing Address
First Line	:	100 CHICKASAW DR
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39401-2852
Country	:	US
Telephone Number	:	601-705-1901
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CHICKASAW DR
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39401-2852
Country	:	US
Telephone Number	:	601-705-1901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2009
Last Update Date	:	08/05/2025

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