Provider Demographics
NPI:1942777610
Name:HOLT, AUDRIS (TCM)
Entity Type:Individual
Prefix:
First Name:AUDRIS
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6882 LAKE MIST LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-0450
Mailing Address - Country:US
Mailing Address - Phone:904-762-8710
Mailing Address - Fax:
Practice Address - Street 1:2400 EDGEWOOD AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-1727
Practice Address - Country:US
Practice Address - Phone:904-781-7797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health