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General NPI Number Information
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NPI Number | 1124698717
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Entity Type | Individual
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Provider Name | CHRISTINA HOLDSCLAW LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 1175 REVOLUTION MILL DR # 29-3
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City | GREENSBORO
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State | NC
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Zip | 27405-5079
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Country | US
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Telephone | 336-296-8822
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Fax |
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Provider Business Mailing Address
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Address Line | 2389 SEDGEMONT DR
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City | WINSTON SALEM
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State | NC
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Zip | 27103-9795
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Country | US
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Telephone | 336-970-0178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A16669
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License Number State | NC
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