Provider Demographics
NPI:1003400227
Name:STORK, CAROLINE HONORA (LSW, CCTP, CADC)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:HONORA
Last Name:STORK
Suffix:
Gender:F
Credentials:LSW, CCTP, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 HIGHWAY 105
Mailing Address - Street 2:
Mailing Address - City:PALMER LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80133-9003
Mailing Address - Country:US
Mailing Address - Phone:719-884-0063
Mailing Address - Fax:
Practice Address - Street 1:443 HIGHWAY 105
Practice Address - Street 2:
Practice Address - City:PALMER LAKE
Practice Address - State:CO
Practice Address - Zip Code:80133-9003
Practice Address - Country:US
Practice Address - Phone:719-884-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009923449104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker