Healthcare Provider Details

I. General information

NPI: 1871946566
Provider Name (Legal Business Name): CAROL L CARR, LPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 LIBERTY LN SUITE 5
WESCOSVILLE PA
18106-9014
US

IV. Provider business mailing address

4949 LIBERTY LN SUITE 5
WESCOSVILLE PA
18106-9014
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 NumberPC001259PA
License Number StatePA

VIII. Authorized Official

Name: MS. CAROL L CARR
Title or Position: SOLE PROPRIETOR
Credential: LPC
Phone: 610-821-9422