Basic Information
| Provider Information | |||||||||
| NPI: | 1992119663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLT | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 WEDGEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | ZEBULON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275972223 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3012 FALSTAFF RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276101813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196151027 | ||||||||
| FaxNumber: | 9196151501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2014 | ||||||||
| LastUpdateDate: | 03/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P008872 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.