Provider Demographics
NPI:1437464419
Name:HOLT, NICHOLAS VALCHAR (LCSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:VALCHAR
Last Name:HOLT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:11303 W WASHINGTON BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-6003
Mailing Address - Country:US
Mailing Address - Phone:213-842-9064
Mailing Address - Fax:
Practice Address - Street 1:11303 W WASHINGTON BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6003
Practice Address - Country:US
Practice Address - Phone:213-842-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA671951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program