Healthcare Provider Details

I. General information

NPI: 1568496644
Provider Name (Legal Business Name): MS. CAROL L CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 LIBERTY LN SUITE 5
WESCOSVILLE PA
18106-9017
US

IV. Provider business mailing address

4949 LIBERTY LN SUITE 5
WESCOSVILLE PA
18106-9017
US

V. Phone/Fax

Practice location:
  • Phone: 610-821-9422
  • Fax: 610-820-6308
Mailing address:
  • Phone: 610-821-9422
  • Fax: 610-820-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC 001259
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: