Provider Demographics
NPI:1336989581
Name:FREDRICKSEN, CARRIE (LPC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:FREDRICKSEN
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 1:2226 W NEWTON LN
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-4939
Mailing Address - Country:US
Mailing Address - Phone:520-271-6319
Mailing Address - Fax:
Practice Address - Street 1:2226 W NEWTON LN
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-4939
Practice Address - Country:US
Practice Address - Phone:520-271-6319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-19512101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional