Provider Demographics
NPI:1588157200
Name:HOLTZ, NICHELLE SHONTAE (MS)
Entity type:Individual
Prefix:MISS
First Name:NICHELLE
Middle Name:SHONTAE
Last Name:HOLTZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 GA HIGHWAY 16 W
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-7107
Mailing Address - Country:US
Mailing Address - Phone:770-229-3407
Mailing Address - Fax:
Practice Address - Street 1:1710 GA HIGHWAY 16 W
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-7107
Practice Address - Country:US
Practice Address - Phone:770-229-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health