Provider Demographics
NPI:1194337105
Name:DINGWALL, CARISSA (LPC)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:DINGWALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 MILLENNIUM CIR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2775
Mailing Address - Country:US
Mailing Address - Phone:706-935-5000
Mailing Address - Fax:706-410-2273
Practice Address - Street 1:76 MILLENNIUM CIR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2775
Practice Address - Country:US
Practice Address - Phone:706-935-5000
Practice Address - Fax:706-410-2273
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC006184OtherLPC LICENSE