Provider Demographics
NPI:1720604341
Name:STOFANAK, CARRIE (LCPC, LPCMH)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:STOFANAK
Suffix:
Gender:F
Credentials:LCPC, LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-4702
Mailing Address - Country:US
Mailing Address - Phone:302-359-4333
Mailing Address - Fax:
Practice Address - Street 1:8 5TH AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4702
Practice Address - Country:US
Practice Address - Phone:302-359-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP14071101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional