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NPI Code Detail

MEDICARE: MS. KELLI ELIZABETH HOLDT

MEDICARE: MS. KELLI ELIZABETH HOLDT
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
1101YM0800XMental Health Counselor
2101YM0800XMental Health CounselorP010108NC
31041C0700XClinical Social WorkerC011204NC

General Provider Information

NPI Number : 1881870772
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLI ELIZABETH HOLDT
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9101 MONROE RD STE 155
Second Line :
City : CHARLOTTE
State : NC
Zip : 28270-2467
Country : US
Telephone Number : 704-384-1260
Fax Number : 704-384-1289
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2008
Last Update Date : 04/18/2018

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Directions to “ MS. KELLI ELIZABETH HOLDT ” Practice Location

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