Provider Demographics
NPI:1497381859
Name:HOLT, MARCELLA (LCSW)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:HOLT
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 JAMES JACKSON PKWY NW APT 203
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-0659
Mailing Address - Country:US
Mailing Address - Phone:404-780-6716
Mailing Address - Fax:
Practice Address - Street 1:1212 JAMES JACKSON PKWY NW APT 203
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-0659
Practice Address - Country:US
Practice Address - Phone:404-780-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OHRBT-19-91100106S00000X
GACSW0095621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician