Healthcare Provider Details

I. General information

NPI: 1144732892
Provider Name (Legal Business Name): MICHELE MARIE HOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CAMINO DIABLO STE 120
WALNUT CREEK CA
94597-3979
US

IV. Provider business mailing address

2950 CAMINO DIABLO STE 120
WALNUT CREEK CA
94597-3979
US

V. Phone/Fax

Practice location:
  • Phone: 925-287-1747
  • Fax: 925-254-3277
Mailing address:
  • Phone: 925-287-1747
  • Fax: 925-254-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: