Provider Demographics
NPI:1669062261
Name:HOLDER, JOSHUA (QMHP-T)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HOLDER
Suffix:
Gender:M
Credentials:QMHP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 HALE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663-1950
Mailing Address - Country:US
Mailing Address - Phone:757-771-1368
Mailing Address - Fax:
Practice Address - Street 1:780 LYNNHAVEN PKWY STE 410
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7332
Practice Address - Country:US
Practice Address - Phone:757-301-9065
Practice Address - Fax:866-499-8840
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-20-132545106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VARBT-20-132545OtherREGISTERED BEHAVIOR TECHNICIAN