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General NPI Number Information
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NPI Number | 1063822666
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Entity Type | Individual
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Provider Name | CAROLYN JOYCE MACOMBER LPC
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Gender | Female
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 08/08/2017
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Provider Practice Location Address
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Address Line | 1011 BROADWAY ST STE 10
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City | NILES
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State | MI
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Zip | 49120-2762
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Country | US
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Telephone | 269-485-1505
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 BROADWAY ST STE10
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City | NILES
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State | MI
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Zip | 49120-2762
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Country | US
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Telephone | 269-845-1505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401013902
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401013902
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License Number State | MI
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