Provider Demographics
NPI:1316248297
Name:HARRINGTON, CAROLYN ETHERIDGE (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ETHERIDGE
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4334
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-0006
Mailing Address - Country:US
Mailing Address - Phone:804-677-3866
Mailing Address - Fax:
Practice Address - Street 1:5322 STOKES LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1918
Practice Address - Country:US
Practice Address - Phone:804-677-3866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0812000066103T00000X
VA09040028671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist