Healthcare Provider Details

I. General information

NPI: 1518189836
Provider Name (Legal Business Name): NANCY LEWIS HOLTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 LONG LAKE DR
BRIGHTON MI
48114-9637
US

IV. Provider business mailing address

1498 LONG LAKE DR
BRIGHTON MI
48114-9637
US

V. Phone/Fax

Practice location:
  • Phone: 248-335-0632
  • Fax: 248-335-1067
Mailing address:
  • Phone: 248-335-0632
  • Fax: 248-335-1067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801058814
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: