Provider Demographics
NPI:1487355475
Name:VILLAGECENTER, CAROLYN MARY
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MARY
Last Name:VILLAGECENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 FORTY MILE AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3110
Mailing Address - Country:US
Mailing Address - Phone:907-456-6445
Mailing Address - Fax:907-456-6402
Practice Address - Street 1:209 FORTY MILE AVENUE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3110
Practice Address - Country:US
Practice Address - Phone:907-456-6445
Practice Address - Fax:907-456-6402
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)