Provider Demographics
NPI:1104952894
Name:GOVER, CAROLYN JEANNETTE (MA, NCC, LPC)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:JEANNETTE
Last Name:GOVER
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LANDING DR
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-9766
Mailing Address - Country:US
Mailing Address - Phone:302-226-3661
Mailing Address - Fax:302-226-9070
Practice Address - Street 1:125 LANDING DR
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-9766
Practice Address - Country:US
Practice Address - Phone:302-226-3661
Practice Address - Fax:302-226-9070
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000022261Medicaid