Provider Demographics
NPI:1427425214
Name:CAROL G. FOUNTAIN WOOTEN, MA, PLLC
Entity type:Organization
Organization Name:CAROL G. FOUNTAIN WOOTEN, MA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:G FOUNTAIN
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:919-928-3611
Mailing Address - Street 1:1709 LEGION RD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2375
Mailing Address - Country:US
Mailing Address - Phone:919-928-3611
Mailing Address - Fax:919-929-8006
Practice Address - Street 1:1709 LEGION RD
Practice Address - Street 2:SUITE 224
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2375
Practice Address - Country:US
Practice Address - Phone:919-928-3611
Practice Address - Fax:919-929-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty