Provider Demographics
NPI:1902621287
Name:COLVIN, CARRIE RUTH (LCPC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:RUTH
Last Name:COLVIN
Suffix:
Gender:X
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26736 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-3466
Mailing Address - Country:US
Mailing Address - Phone:708-845-8065
Mailing Address - Fax:
Practice Address - Street 1:1512 ARTAIUS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5231
Practice Address - Country:US
Practice Address - Phone:847-444-9244
Practice Address - Fax:847-461-1006
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.016552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional