Healthcare Provider Details

I. General information

NPI: 1588576391
Provider Name (Legal Business Name): CALETHIA ROLLING VISTA CT HOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CALLIE HOLT

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7824 ROLLING VISTA CT
NOTTINGHAM MD
21236-3643
US

IV. Provider business mailing address

7824 ROLLING VISTA CT
NOTTINGHAM MD
21236-3643
US

V. Phone/Fax

Practice location:
  • Phone: 917-881-2253
  • Fax:
Mailing address:
  • Phone: 917-881-2253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: