Provider Demographics
NPI:1730453044
Name:VAN PELT, CARLA M (LCADC-I)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:M
Last Name:VAN PELT
Suffix:
Gender:F
Credentials:LCADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E LONG ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-2505
Mailing Address - Country:US
Mailing Address - Phone:775-461-0025
Mailing Address - Fax:
Practice Address - Street 1:119 E LONG ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-2505
Practice Address - Country:US
Practice Address - Phone:775-461-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV08091-LCI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty