Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 192 | NH |
NPI | 1003093709 |
---|---|
Provider Name | Jason D Holder |
First Address | Danville, NH 03819-0395 |
Second Address | Danville, NH 03819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2008 |
Last Update Date | 24/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30009729 | (05) | NH |