Provider Demographics
NPI:1023354966
Name:HOLDER, LEE BROOKS (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:LEE
Middle Name:BROOKS
Last Name:HOLDER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GRINNELL RD
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2039
Mailing Address - Country:US
Mailing Address - Phone:603-502-2780
Mailing Address - Fax:
Practice Address - Street 1:6 GRINNELL RD
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2039
Practice Address - Country:US
Practice Address - Phone:603-432-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1023354966Medicaid