Provider Demographics
NPI:1568509222
Name:HOLSTAD, MICHELE A (LPC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:A
Last Name:HOLSTAD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:A
Other - Last Name:HIBBARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:951 HARMONY RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-9601
Mailing Address - Country:US
Mailing Address - Phone:678-464-6853
Mailing Address - Fax:
Practice Address - Street 1:951 HARMONY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9601
Practice Address - Country:US
Practice Address - Phone:678-464-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
GALPC002598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)