Healthcare Provider Details

I. General information

NPI: 1992820674
Provider Name (Legal Business Name): GRETA BUYCK HOLT M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 LADYS ISLAND DR
BEAUFORT SC
29907-1643
US

IV. Provider business mailing address

PO BOX 307
SAINT HELENA ISLAND SC
29920-0307
US

V. Phone/Fax

Practice location:
  • Phone: 843-816-7555
  • Fax:
Mailing address:
  • Phone: 843-816-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4634
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: