Provider Demographics
NPI:1275148132
Name:HOLTKAMP, JOHN JOSEPH (MSW, LISW-S, LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:HOLTKAMP
Suffix:
Gender:M
Credentials:MSW, LISW-S, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 WALNUT GROVE DR
Mailing Address - Street 2:
Mailing Address - City:JARRATT
Mailing Address - State:VA
Mailing Address - Zip Code:23867-8611
Mailing Address - Country:US
Mailing Address - Phone:434-634-3217
Mailing Address - Fax:
Practice Address - Street 1:546 WALNUT GROVE DR
Practice Address - Street 2:
Practice Address - City:JARRATT
Practice Address - State:VA
Practice Address - Zip Code:23867-8611
Practice Address - Country:US
Practice Address - Phone:434-634-3217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040113481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical