Provider Demographics
NPI:1033150628
Name:COONS, CARYN MARIE (LPC-S)
Entity Type:Individual
Prefix:MS
First Name:CARYN
Middle Name:MARIE
Last Name:COONS
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3202
Mailing Address - Country:US
Mailing Address - Phone:910-799-1071
Mailing Address - Fax:910-799-3313
Practice Address - Street 1:1041 OLD OCEAN HWY
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8584
Practice Address - Country:US
Practice Address - Phone:910-754-7908
Practice Address - Fax:910-799-3313
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC 3338101YP2500X
NCLPC 3445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102265Medicaid
SC043677617OtherFORMER TAX ID OF OLD CORP