Provider Demographics
NPI:1720793730
Name:HOLT, GRACE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N KENSINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-1035
Mailing Address - Country:US
Mailing Address - Phone:703-447-5851
Mailing Address - Fax:
Practice Address - Street 1:7001 HERITAGE VILLAGE PLZ STE 230
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3095
Practice Address - Country:US
Practice Address - Phone:571-445-4990
Practice Address - Fax:571-775-3806
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health