Provider Demographics
NPI:1417538331
Name:SOTO HOLGATE, HEIDI (LCSW-A)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:SOTO HOLGATE
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 SUNBOW FALLS LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8133
Mailing Address - Country:US
Mailing Address - Phone:270-404-6784
Mailing Address - Fax:
Practice Address - Street 1:3720 BENSON DR STE AND102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7321
Practice Address - Country:US
Practice Address - Phone:984-325-6889
Practice Address - Fax:252-226-1243
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NCP0205861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician