Provider Demographics
NPI:1891103602
Name:MOTA, CAROLYN (MS/MA)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:MOTA
Suffix:
Gender:F
Credentials:MS/MA
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:MOTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS/MA
Mailing Address - Street 1:5910 STRICKLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812
Mailing Address - Country:US
Mailing Address - Phone:617-952-9481
Mailing Address - Fax:
Practice Address - Street 1:801 DOUGLAS AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-5206
Practice Address - Country:US
Practice Address - Phone:407-830-6312
Practice Address - Fax:407-830-8413
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health