Provider Demographics
NPI: | 1033884101 |
---|---|
Name: | GIBLIN, CAROLINE BARKER (LLPC) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | CAROLINE |
Middle Name: | BARKER |
Last Name: | GIBLIN |
Suffix: | |
Gender: | F |
Credentials: | LLPC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2528 W WACKERLY ST |
Mailing Address - Street 2: | |
Mailing Address - City: | MIDLAND |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48640-6921 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 989-832-0191 |
Mailing Address - Fax: | 989-486-9413 |
Practice Address - Street 1: | 2528 W WACKERLY ST |
Practice Address - Street 2: | |
Practice Address - City: | MIDLAND |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48640-6921 |
Practice Address - Country: | US |
Practice Address - Phone: | 989-859-7633 |
Practice Address - Fax: | 989-486-9413 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2021-08-11 |
Last Update Date: | 2021-08-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 6451019404 | 101YM0800X, 101YP2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MI | 6451019404 | Other | 15180792 |