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NPI Code Detail

MEDICARE: MICHAEL HOLSTEN MSW, LCSW

MEDICARE: MICHAEL HOLSTEN MSW, LCSW
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
11041C0700XClinical Social WorkerC010308NC
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1700294899
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL HOLSTEN MSW, LCSW
Provider Business Mailing Address
First Line : 6112 SAINT GILES ST
Second Line :
City : RALEIGH
State : NC
Zip : 27612-7043
Country : US
Telephone Number : 919-893-4465
Fax Number :
Provider Business Practice Location Address
First Line : 6112 SAINT GILES ST
Second Line :
City : RALEIGH
State : NC
Zip : 27612-7043
Country : US
Telephone Number : 919-893-4465
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2014
Last Update Date : 12/04/2024

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