Provider Demographics
NPI:1386229227
Name:CARMACK AARON, AUDRIE CAROLINE (LICSW)
Entity type:Individual
Prefix:
First Name:AUDRIE
Middle Name:CAROLINE
Last Name:CARMACK AARON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2939
Mailing Address - Country:US
Mailing Address - Phone:256-267-4746
Mailing Address - Fax:
Practice Address - Street 1:13 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2939
Practice Address - Country:US
Practice Address - Phone:256-267-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4517C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical