Provider Demographics
NPI:1306276019
Name:HOLDER, TERRENCE HOLDER
Entity type:Individual
Prefix:
First Name:TERRENCE HOLDER
Middle Name:
Last Name:HOLDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WALDEN LANDING DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6232
Mailing Address - Country:US
Mailing Address - Phone:678-887-7511
Mailing Address - Fax:
Practice Address - Street 1:104 WALDEN LANDING DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6232
Practice Address - Country:US
Practice Address - Phone:678-887-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker