Provider Demographics
NPI:1801018510
Name:HOLTER, TERI L (LCSW, DCSW)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:L
Last Name:HOLTER
Suffix:
Gender:F
Credentials:LCSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-0458
Mailing Address - Country:US
Mailing Address - Phone:808-205-8055
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:1170 MAKAWAO AVE
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9448
Practice Address - Country:US
Practice Address - Phone:808-572-5551
Practice Address - Fax:808-572-5554
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-10761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI566763.01Medicaid
HI566763.01Medicaid