Healthcare Provider Details

I. General information

NPI: 1477886489
Provider Name (Legal Business Name): LAURA LOUISE HOLT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10025 W MARKHAM ST STE 210
LITTLE ROCK AR
72205-2178
US

IV. Provider business mailing address

10025 W MARKHAM ST STE 210
LITTLE ROCK AR
72205-2178
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-5473
  • Fax: 501-661-1812
Mailing address:
  • Phone: 501-663-5473
  • Fax: 501-661-1812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1315-C
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number1315-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: