Provider Demographics
NPI:1992454417
Name:HOLT, MYA KIARA
Entity type:Individual
Prefix:
First Name:MYA
Middle Name:KIARA
Last Name:HOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10309 CONGRESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2124
Mailing Address - Country:US
Mailing Address - Phone:410-804-3587
Mailing Address - Fax:
Practice Address - Street 1:10309 CONGRESSIONAL CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2124
Practice Address - Country:US
Practice Address - Phone:410-804-3587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities