Healthcare Provider Details

I. General information

NPI: 1952324592
Provider Name (Legal Business Name): CHARLES A. HOLTON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 LAKE BOONE TRL SUITE 201
RALEIGH NC
27607-7512
US

IV. Provider business mailing address

100 EUROPA DR SUITE 260
CHAPEL HILL NC
27517-2357
US

V. Phone/Fax

Practice location:
  • Phone: 919-785-0384
  • Fax: 919-785-0038
Mailing address:
  • Phone: 919-929-1227
  • Fax: 919-968-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC000273
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: