Healthcare Provider Details

I. General information

NPI: 1013700533
Provider Name (Legal Business Name): DESTINY HOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W MICHIGAN AVE
LANSING MI
48917-2856
US

IV. Provider business mailing address

2805 S INDUSTRIAL HWY STE 100
ANN ARBOR MI
48104-6791
US

V. Phone/Fax

Practice location:
  • Phone: 517-258-0052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: