Provider Demographics
NPI:1891436978
Name:HOLT, MISCHELLE ELAINE
Entity Type:Individual
Prefix:
First Name:MISCHELLE
Middle Name:ELAINE
Last Name:HOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MISCHELLE
Other - Middle Name:
Other - Last Name:RHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28975 BALMORAL ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2162
Mailing Address - Country:US
Mailing Address - Phone:404-840-8403
Mailing Address - Fax:
Practice Address - Street 1:28975 BALMORAL ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2162
Practice Address - Country:US
Practice Address - Phone:404-840-8403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator