Provider Demographics
NPI:1902168859
Name:HOLT, KATHRYN CLARISSA (P-LCSW)
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:CLARISSA
Last Name:HOLT
Suffix:
Gender:F
Credentials:P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 MELLOW FIELD DR, STE 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604
Mailing Address - Country:US
Mailing Address - Phone:336-244-9142
Mailing Address - Fax:
Practice Address - Street 1:5505 CREEDMOOR RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6333
Practice Address - Country:US
Practice Address - Phone:919-852-5352
Practice Address - Fax:919-852-5323
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0065411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical