Deidere Hollins, LPC-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

1628 Issued in MS

Practice address

3450 Highway 80 W
Jackson, MS 39209-7201

Phone

(601) 321-2400

Fax

(601) 985-5174

NPI assigned

Jun 19, 2015

Last updated

Jul 11, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of Mississippi - University of Mississippi Medical CenterGroup PAC ID 1850293036, 956 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: dhollins226899@ummc.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• State of Mississippi - University of Mississippi Medical Center

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1154317527
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1336521970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 MAGNOLIA WAY",
            "city": "PEARL",
            "state": "MS",
            "postal_code": "392083366",
            "telephone_number": "601-573-9849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 HIGHWAY 80 W",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392097201",
            "telephone_number": "601-321-2400",
            "fax_number": "601-985-5174"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 Magnolia Way",
            "address_purpose": "LOCATION",
            "city": "Pearl",
            "state": "MS",
            "postal_code": "392083366",
            "country_code": "US",
            "telephone_number": "601-573-9849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLINS",
        "first_name": "DEIDERE",
        "credential": "LPC-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-19",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "1628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00018209",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tyler James Holland
• Brianna Holley
• Danielle Elizabeth Holliday
• Melanie Holliday
• Patricia B Holliday, PH.D.
• Jacquelynn Hollins
• Patricia Hollins
• Carolyn Holloway
• Myeshia Natavia Holloway, CNA
• Santana Holloway

• Professional Counselor in Jackson, MS
• Providers in Jackson, MS by specialty
• Professional Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.