Provider Demographics
NPI:1194065441
Name:HOLSATHER, TIMOTHY (LMFT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HOLSATHER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 PRESTWICK LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4129
Mailing Address - Country:US
Mailing Address - Phone:910-616-2156
Mailing Address - Fax:
Practice Address - Street 1:624 US HIGHWAY 17 S
Practice Address - Street 2:STE. 2
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-8660
Practice Address - Country:US
Practice Address - Phone:910-616-2156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1599106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist