Provider Demographics
NPI:1003232968
Name:MYERS, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:TN
Mailing Address - Zip Code:37415-2746
Mailing Address - Country:US
Mailing Address - Phone:404-455-2824
Mailing Address - Fax:
Practice Address - Street 1:1875 FANT DRIVE
Practice Address - Street 2:LOOKOUT MOUNTAIN COMMUNITY SERVICES
Practice Address - City:FT. OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742
Practice Address - Country:US
Practice Address - Phone:706-861-3387
Practice Address - Fax:706-806-1186
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007677101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor