Provider Demographics
NPI:1043542509
Name:ACOSTA, CAROLINA (LPC)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:NIMIA
Other - Middle Name:C
Other - Last Name:CABEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6511
Mailing Address - Country:US
Mailing Address - Phone:262-345-5560
Mailing Address - Fax:262-345-5531
Practice Address - Street 1:9505 W BROWN DEER RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-2011
Practice Address - Country:US
Practice Address - Phone:262-345-5561
Practice Address - Fax:262-345-5562
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4123125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100008077Medicaid