Provider Demographics
NPI:1285385799
Name:FAIFMAN, CAROLINE COULTER (LMHC)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:COULTER
Last Name:FAIFMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:COULTER
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5042 NIGHT STAR TRL
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4575
Mailing Address - Country:US
Mailing Address - Phone:203-414-1854
Mailing Address - Fax:
Practice Address - Street 1:5042 NIGHT STAR TRL
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-4575
Practice Address - Country:US
Practice Address - Phone:203-414-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health