Provider Demographics
NPI:1154625101
Name:PEREZ, CAROLINA ANNA (LPC, CADC-II)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:ANNA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LPC, CADC-II
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:ANNA
Other - Last Name:KELLENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHP,LADC,LPC,CADC
Mailing Address - Street 1:655 7TH ST BLDG 707
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31098-2227
Mailing Address - Country:US
Mailing Address - Phone:478-926-4035
Mailing Address - Fax:
Practice Address - Street 1:655 7TH ST BLDG 707
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-926-4035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1266101YA0400X
NE1220101YA0400X
NE4216101YM0800X
GA009908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$15Medicaid