Healthcare Provider Details

I. General information

NPI: 1861654212
Provider Name (Legal Business Name): CAROL H ARLINE MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 6TH AVE W
BRADENTON FL
34205-8820
US

IV. Provider business mailing address

4603 4TH AVE E
BRADENTON FL
34208-8448
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4299
  • Fax:
Mailing address:
  • Phone: 772-713-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 9926
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: