Individual
DEIDERE HOLLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-S
Contact information
Practice address
3450 HIGHWAY 80 W, JACKSON, MS 39209-7201
(601) 321-2400
(601) 985-5174
Mailing address
109 MAGNOLIA WAY, PEARL, MS 39208-3366
(601) 573-9849
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1628
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018209
—
MS
Enumeration date
06/19/2015
Last updated
07/11/2018
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