Provider Demographics
NPI:1497381859
Name:HOLT, MARCELLA (MSW)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6229
Mailing Address - Country:US
Mailing Address - Phone:404-780-6716
Mailing Address - Fax:770-389-3077
Practice Address - Street 1:831 FAIRWAYS CT # A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7278
Practice Address - Country:US
Practice Address - Phone:770-389-1925
Practice Address - Fax:770-389-3077
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-19-91100106S00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician