Provider Demographics
NPI:1639305220
Name:HOLT, CHARLIE (MSW)
Entity type:Individual
Prefix:MR
First Name:CHARLIE
Middle Name:
Last Name:HOLT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:R
Other - Last Name:HOLT
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:15301 WARREN SHINGLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BEALE AFB
Mailing Address - State:CA
Mailing Address - Zip Code:95903-1907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15301 WARREN SHINGLE ROAD
Practice Address - Street 2:
Practice Address - City:BEALE AFB
Practice Address - State:CA
Practice Address - Zip Code:95903-1907
Practice Address - Country:US
Practice Address - Phone:530-634-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OHI.11012561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker