Individual
MR. JOSHUA KERMIT HOLLINGSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A
Contact information
Practice address
5740 GETWELL RD STE D, SOUTHAVEN, MS 38672-6346
(601) 790-0583
Mailing address
5703 BEDFORD LOOP E, SOUTHAVEN, MS 38672-7534
(530) 220-3643
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2921
MS
101YM0800X
Mental Health Counselor
60105
CA
225400000X
Rehabilitation Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2921
MEDICAL
MS
01
—
7184
MEDICAL
CA
01
—
7368
MEDICAL
CA
01
—
7667
MEDICAL
CA
01
—
7708
MEDICAL
CA
Enumeration date
07/21/2009
Last updated
07/03/2024
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