MEDICARE: CAROL L CARR, LPC LLC

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	101YP2500X	Professional Counselor	PC001259PA	PA

General Provider Information

NPI Number	:	1871946566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROL L CARR, LPC LLC

Provider Business Mailing Address
First Line	:	4949 LIBERTY LN
Second Line	:	SUITE 5
City	:	WESCOSVILLE
State	:	PA
Zip	:	18106-9014
Country	:	US
Telephone Number	:	610-821-9422
Fax Number	:	610-820-6308

Provider Business Practice Location Address
First Line	:	4949 LIBERTY LN
Second Line	:	SUITE 5
City	:	WESCOSVILLE
State	:	PA
Zip	:	18106-9014
Country	:	US
Telephone Number	:	610-821-9422
Fax Number	:	610-820-6308

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MS. CAROL L CARR
Credential	:	LPC
Telephone Number	:	610-821-9422

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	07/18/2016

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