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General NPI Number Information
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NPI Number | 1609344589
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Entity Type | Individual
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Provider Name | CAROLYN DIANE SCHULZE LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 01/14/2023
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Provider Practice Location Address
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Address Line | 260 S MARION AVE STE 135
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City | LAKE CITY
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State | FL
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Zip | 32025-7000
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Country | US
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Telephone | 386-697-8842
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Fax | 386-406-8340
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Provider Business Mailing Address
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Address Line | 7910 COUNTY ROAD 252
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City | LIVE OAK
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State | FL
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Zip | 32060-6860
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Country | US
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Telephone | 386-688-3979
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW15532
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License Number State | FL
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