Provider Demographics
NPI:1669353777
Name:HOLT, MICHAEL (CDCA 193459)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:HOLT
Suffix:
Gender:M
Credentials:CDCA 193459
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6174 ALBANY CREST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8793
Mailing Address - Country:US
Mailing Address - Phone:614-505-3126
Mailing Address - Fax:
Practice Address - Street 1:246 E CAMPUS VIEW BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4634
Practice Address - Country:US
Practice Address - Phone:614-505-3126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH193459101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)