Provider Demographics
NPI:1548663362
Name:HOLT COUNSELING CENTER
Entity type:Organization
Organization Name:HOLT COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-983-3308
Mailing Address - Street 1:315 W PINE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-2074
Mailing Address - Country:US
Mailing Address - Phone:209-366-2273
Mailing Address - Fax:209-366-2974
Practice Address - Street 1:315 W PINE ST
Practice Address - Street 2:STE 3
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-2047
Practice Address - Country:US
Practice Address - Phone:209-366-2273
Practice Address - Fax:209-366-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 9454251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health