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General NPI Number Information
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NPI Number | 1881059145
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Entity Type | Individual
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Provider Name | CARMEN CARL
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Gender | Female
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 9146 E STOCKTON BLVD STE 1135
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City | ELK GROVE
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State | CA
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Zip | 95624-9510
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Country | US
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Telephone | 209-730-6425
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 401
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City | WILTON
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State | CA
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Zip | 95693-0401
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Country | US
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Telephone | 916-416-5019
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCC17218
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License Number State | CA
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