Provider Demographics
NPI:1053354027
Name:HOLFORD, ASHLEY HAYNES (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:HAYNES
Last Name:HOLFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-261-1650
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:102 MEDICAL PARK STE B
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-9080
Practice Address - Country:US
Practice Address - Phone:601-261-1650
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC5392104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122900Medicaid
MS800012938OtherMEDICARE RAILROAD