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Individual
MRS. JESSICA DENISE HOLTON
Active
Individual
MRS. JESSICA DENISE HOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, LCAS
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
963
NC
1041C0700X
Clinical Social Worker
Primary
C005187
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11612221
CAQH UNIVERSAL DATA SOURC
—
01
—
142CH
BLUECROSS BLUESHIELD
NC
05
—
1780727909
—
NC
01
—
447992
TRICARE PIN
NC
01
—
56162
MEDCOST
NC
Enumeration date
02/15/2007
Last updated
11/29/2021
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