DEIDERE HOLLINS (NPI# 1336521970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336521970 |
| Entity Type | Individual |
| Full Name | DEIDERE HOLLINS |
| Credential | LPC-S |
| Practice Address |
3450 Highway 80 W Jackson MS 39209-7201 |
| Mailing Address |
109 Magnolia Way Pearl MS 39208-3366 |
| Practice Telephone | 6013212400 |
| Practice Fax Number | 6019855174 |
| Mailing Telephone | 6015739849 |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2018-07-11 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
1628 | MS | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00018209 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 109 Magnolia Way, Pearl, MS 392083366 | 6015739849 |
| Street Address |
3450 HIGHWAY 80 W |
| City | JACKSON |
| State | MS |
| Zip Code | 39209-7201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164468468 | Jeffrey Asgar Ali | Psychiatry & Neurology | 3450 Highway 80 W, Jackson, MS 39209-7201 | 2006-06-22 |
| 1649878216 | Donna Brown | Counselor | 3450 Highway 80 W, Jackson, MS 39209-7201 | 2020-10-15 |
| 1831797471 | Tecola Bradley | Counselor | 3450 Highway 80 W, Jackson, MS 39209-7201 | 2020-10-15 |
| 1093313660 | Detrick Johnson | Counselor | 3450 Highway 80 W, Jackson, MS 39209-7201 | 2020-10-15 |
| 1902404460 | Brittany C Bloodsaw | Counselor | 3450 Highway 80 W, Jackson, MS 39209-7201 | 2020-10-15 |
| 1497353957 | Lakeshia L Sutton | Counselor | 3450 Highway 80 W, Jackson, MS 39209-7201 | 2020-10-15 |
| 1134727605 | Maya D Dezell | Counselor | 3450 Highway 80 W, Jackson, MS 39209-7201 | 2020-10-15 |
| 1275131740 | Karla Banks | Social Worker | 3450 Highway 80 W, Jackson, MS 39209-7201 | 2020-10-15 |
| 1881292340 | Lyser N Selmon | Counselor | 3450 Highway 80 W, Jackson, MS 39209-7201 | 2020-10-15 |
| 1568078566 | Maricus Walker | Counselor | 3450 Highway 80 W, Jackson, MS 39209-7201 | 2020-09-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235754995 | Oak Street Health Physicians Group of Mississippi, LLC | Family Medicine | 911 Ellis Ave, Jackson, MS 39209 | 2020-06-09 |
| 1760003594 | Phi Health, LLC | Ambulance | 582 Ramp Road, Suite C, Jackson, MS 39209 | 2020-05-04 |
| 1720468911 | Genoa Healthcare, LLC | Pharmacy | 3450 Highway 80 W Rm 68, Jackson, MS 39209 | 2015-06-03 |
| 1013302082 | Tiffany Griffin | Nurse Practitioner | 3450 Highway 80 West, Jackson, MS 39209 | 2015-04-06 |
| 1679961957 | Cassetta Shontae Mcgee | Emergency Medical Technician, Basic | 5326 Queen Eleanor Ln, Jackson, MS 39209 | 2015-01-08 |
| 1124381280 | Martin Solution | In Home Supportive Care | 917 West Ridge, Jackson, MS 39209 | 2012-06-22 |
| 1649533589 | Adrinnie M Martin | Contractor | 917 Westridge, Jackson, MS 39209 | 2012-06-15 |
| 1831423862 | Infinity House, Inc | In Home Supportive Care | 1042 Pecan Park Circle, Jackson, MS 39209 | 2009-09-23 |
| 1174751093 | Linda M Vance | Nurse Practitioner | 1000 Metrocenter Ste 105, Jackson, MS 39209 | 2009-06-30 |
| 1770729998 | Kim Hestle | Speech-Language Pathologist | 733 N. Flag Chapel Road, Jackson, MS 39209 | 2008-12-17 |
| Find all providers in zip 39209 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902411663 | Kristen Camille Kapler | Counselor | 3899 Division Rd, Jackson, WI 53037-9707 | 2020-09-10 |
| 1992339071 | Open Door Family Counseling | Counselor | 316 S Brown St Ste A, Jackson, MI 49203-1481 | 2020-02-27 |
| 1891334108 | Jamie Alane Merrill | Counselor | 1214 Greenwood Ave, Jackson, MI 49203-3037 | 2020-01-03 |
| 1285273078 | Hall Consulting Services LLC | Counselor | 1155 Briarwood Dr, Jackson, MS 39211-4204 | 2019-12-27 |
| 1114496387 | New Direction Counseling Center, LLC | Counselor | 1200 N West Ave Ste 809, Jackson, MI 49202-2196 | 2018-11-17 |
| 1811490964 | Lifeworks Resources, LLC | Counselor | 575 S Royal St Ste 24, Jackson, TN 38301-7307 | 2018-03-15 |
| 1912409764 | Impact Behavioral Counseling LLC | Counselor | 1551 E County Line Rd Ste B, Jackson, MS 39211-1801 | 2018-03-07 |
| 1831697317 | Denise June Johnson | Counselor | 906 Lincoln St, Jackson, MI 49202-3251 | 2018-01-30 |
| 1033626031 | Heather R. Chruch | Counselor | 180 W Michigan Ave Ste 204, Jackson, MI 49201-1342 | 2017-12-29 |
| 1861908337 | Matthew T Tompkins | Counselor | 810 E Jackson Blvd Ste B1, Jackson, MO 63755-2400 | 2017-12-20 |
| Find all providers in JACKSON | ||||
Please comment or provide details below to improve the information on DEIDERE HOLLINS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.