Provider Demographics
NPI:1225353436
Name:HOLT, HEEJOON KIM (CSAC)
Entity Type:Individual
Prefix:MR
First Name:HEEJOON
Middle Name:KIM
Last Name:HOLT
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:KIM
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSAC
Mailing Address - Street 1:5636 ALBRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6713
Mailing Address - Country:US
Mailing Address - Phone:757-965-6431
Mailing Address - Fax:
Practice Address - Street 1:5636 ALBRIGHT DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6713
Practice Address - Country:US
Practice Address - Phone:757-965-6431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102619101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)