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General NPI Number Information
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NPI Number | 1548663362
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Entity Type | Organization
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Legal Business Name | HOLT COUNSELING CENTER
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 315 W PINE ST STE 3
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City | LODI
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State | CA
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Zip | 95240-2047
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Country | US
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Telephone | 209-366-2273
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Fax | 209-366-2974
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Provider Business Mailing Address
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Address Line | 315 W PINE ST STE 3
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City | LODI
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State | CA
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Zip | 95240-2074
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Country | US
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Telephone | 209-366-2273
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Fax | 209-366-2974
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANA HOLT
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Credential |
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Telephone | 916-983-3308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCSW 9454
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License Number State | CA
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