Provider Demographics
NPI:1659410801
Name:HOLTZCLAW, KATHERINE G (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:G
Last Name:HOLTZCLAW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2419
Mailing Address - Country:US
Mailing Address - Phone:478-755-0060
Mailing Address - Fax:478-743-3508
Practice Address - Street 1:277 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2419
Practice Address - Country:US
Practice Address - Phone:478-755-0060
Practice Address - Fax:478-743-3508
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000861106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist