Provider Demographics
NPI:1154515807
Name:GAINES, CAROLYN (LPC, LPCC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SUTTLE ST
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-8276
Mailing Address - Country:US
Mailing Address - Phone:970-335-2444
Mailing Address - Fax:970-335-2440
Practice Address - Street 1:185 SUTTLE ST
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-8276
Practice Address - Country:US
Practice Address - Phone:970-335-2444
Practice Address - Fax:970-335-2440
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012840101YM0800X
NM0096351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0012840OtherCOLORADO LPC LICENSE NUMBER
NM0096351OtherLICENSURE