Healthcare Provider Details

I. General information

NPI: 1356898431
Provider Name (Legal Business Name): CAROLYN KINGSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CEMETERY HILL RD
CARROLLTON TX
75007-5096
US

IV. Provider business mailing address

1405-1471 ST PAUL STREET
KELOWNA BRITISH COLUMBIA
V1Y 0K7
CA

V. Phone/Fax

Practice location:
  • Phone: 778-392-7795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number73392
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number73392
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number73392
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number73392
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0017660
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: