Provider Demographics
NPI:1720225220
Name:REBECCA M. HOLDGRAVE, LMFT, INC
Entity Type:Organization
Organization Name:REBECCA M. HOLDGRAVE, LMFT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOLDGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:404-483-1852
Mailing Address - Street 1:3007 SMITH RIDGE TRCE
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2645
Mailing Address - Country:US
Mailing Address - Phone:404-483-1852
Mailing Address - Fax:
Practice Address - Street 1:2993 PIEDMONT RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2768
Practice Address - Country:US
Practice Address - Phone:404-483-1852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALMFT917174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1891847828OtherHUMANA