MEDICARE: CECIL HOLSTON II LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1000494

General Provider Information

NPI Number	:	1235649914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECIL HOLSTON II LSW

Provider Business Mailing Address
First Line	:	2202 PORTSMOUTH AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-4417
Country	:	US
Telephone Number	:	419-279-0933
Fax Number	:

Provider Business Practice Location Address
First Line	:	2332 SAINT JAMES WOODS BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-1228
Country	:	US
Telephone Number	:	419-279-0933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	01/08/2026

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