Provider Demographics
NPI:1962615831
Name:HOLTON, ALTA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:ALTA
Middle Name:ANN
Last Name:HOLTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FLINT RIVER THERAPY ASSOCIATES, INC.
Mailing Address - Street 2:P.O. BOX 7851
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39818
Mailing Address - Country:US
Mailing Address - Phone:229-248-1625
Mailing Address - Fax:
Practice Address - Street 1:231 BRUTON STREET
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39818
Practice Address - Country:US
Practice Address - Phone:229-248-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0024681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical