Provider Demographics
NPI:1407748619
Name:HOLLINS, DR JACQUELINE (THERAPIST)
Entity type:Individual
Prefix:
First Name:DR JACQUELINE
Middle Name:
Last Name:HOLLINS
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PARK PLACE CV STE E
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-8948
Mailing Address - Country:US
Mailing Address - Phone:769-349-0543
Mailing Address - Fax:888-290-7569
Practice Address - Street 1:209 PARK PLACE CV STE E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-8948
Practice Address - Country:US
Practice Address - Phone:769-349-0543
Practice Address - Fax:888-290-7569
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS191102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health