Provider Demographics
NPI:1992814883
Name:HOLT, JOHN L (MA, LPA, LPC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:HOLT
Suffix:
Gender:M
Credentials:MA, LPA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 PINEDALE RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4706
Mailing Address - Country:US
Mailing Address - Phone:336-540-9400
Mailing Address - Fax:336-540-9454
Practice Address - Street 1:2711 PINEDALE RD STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4706
Practice Address - Country:US
Practice Address - Phone:336-540-9400
Practice Address - Fax:336-540-9454
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3942101YM0800X
NCHSP-PA 1255103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107077Medicaid
NCD3325OtherMEDCOST
NC130Y5Medicare UPIN