Provider Demographics
NPI:1275308603
Name:HOLTHAUS, KARA
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:HOLTHAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:VA
Mailing Address - Zip Code:20159-0553
Mailing Address - Country:US
Mailing Address - Phone:703-727-5943
Mailing Address - Fax:
Practice Address - Street 1:829 MOTTER AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4514
Practice Address - Country:US
Practice Address - Phone:703-727-5943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016505101YM0800X
MDLGP14572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health