Provider Demographics
NPI:1891847828
Name:HOLDGRAVE, REBECCA MARIE (LMFT, NCACI)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:HOLDGRAVE
Suffix:
Gender:F
Credentials:LMFT, NCACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 BONNIE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6024
Mailing Address - Country:US
Mailing Address - Phone:404-483-1852
Mailing Address - Fax:478-953-2060
Practice Address - Street 1:100 KATELYN CIR
Practice Address - Street 2:SUITE B
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6481
Practice Address - Country:US
Practice Address - Phone:478-953-2122
Practice Address - Fax:478-953-2060
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA917106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist