Provider Demographics
NPI:1215273586
Name:FORTE, CAROL DAVIS (LPCA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:DAVIS
Last Name:FORTE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 WALTON HEATH DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5905
Mailing Address - Country:US
Mailing Address - Phone:910-476-5402
Mailing Address - Fax:
Practice Address - Street 1:195 WALTON HEATH DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5905
Practice Address - Country:US
Practice Address - Phone:910-476-5402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8791101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health