Provider Demographics
NPI:1588150817
Name:DECAROLIS, CHRISTINE (MED, LPCA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:DECAROLIS
Suffix:
Gender:F
Credentials:MED, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 WINDY RD STE 305
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-2410
Mailing Address - Country:US
Mailing Address - Phone:919-272-1388
Mailing Address - Fax:919-303-5986
Practice Address - Street 1:950 WINDY RD STE 305
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2410
Practice Address - Country:US
Practice Address - Phone:919-272-1388
Practice Address - Fax:919-303-5986
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1098152OtherNATIONAL BOARD OF CERTIFIED COUNSELORS
NCA14066OtherNC BOARD OF LICENSED PROFESSIONAL COUNSELORS