Healthcare Provider Details

I. General information

NPI: 1053665356
Provider Name (Legal Business Name): AMY HOLSTEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 PITCARIN WAY STE A
AUGUSTA GA
30909-5766
US

IV. Provider business mailing address

204 PITCARIN WAY STE A
AUGUSTA GA
30909-5766
US

V. Phone/Fax

Practice location:
  • Phone: 803-220-1611
  • Fax: 833-662-2388
Mailing address:
  • Phone: 803-220-1611
  • Fax: 833-662-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY003677
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: