MEDICARE: MS. GINA HOLT MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	DP00943994	WV

General Provider Information

NPI Number	:	1861927444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GINA HOLT MSW, LICSW

Provider Business Mailing Address
First Line	:	PO BOX 1680
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25717-1680
Country	:	US
Telephone Number	:	304-781-5159
Fax Number	:	304-523-8115

Provider Business Practice Location Address
First Line	:	3729 TEAYS VALLEY RD STE 100
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9705
Country	:	US
Telephone Number	:	304-760-6040
Fax Number	:	304-760-6042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	12/15/2025

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