MEDICARE: CAROLINE ALBRITTON LCDC, LPC-INTERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	12380	TX
2	101YP2500X	Professional Counselor	71494	TX

General Provider Information

NPI Number	:	1821405135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE ALBRITTON LCDC, LPC-INTERN

Provider Business Mailing Address
First Line	:	4320 BELLAIRE DR S
Second Line	:	#239
City	:	FORT WORTH
State	:	TX
Zip	:	76109-5127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 REAGAN ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-3225
Country	:	US
Telephone Number	:	214-999-1044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2014
Last Update Date	:	07/18/2014

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