Provider Demographics
NPI:1467502336
Name:HOLDER, CHRISTOPHER TODD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:TODD
Last Name:HOLDER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:C. TODD
Other - Middle Name:
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 8561
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-0561
Mailing Address - Country:US
Mailing Address - Phone:909-237-0217
Mailing Address - Fax:470-200-6625
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-237-0215
Practice Address - Fax:470-200-6625
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170211041C0700X
CA264091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4898OtherMEDICAL