Provider Demographics
NPI:1376979690
Name:HOLDEN, CHARLES A III (MSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:HOLDEN
Suffix:III
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:A
Other - Last Name:HOLDEN
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:331 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-7108
Mailing Address - Country:US
Mailing Address - Phone:843-662-8275
Mailing Address - Fax:
Practice Address - Street 1:331 LAUREL LN
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-7108
Practice Address - Country:US
Practice Address - Phone:843-662-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical