Provider Demographics
NPI:1043856529
Name:WALCOTT, KARLIN DHARIANA (LMHC, CASAC)
Entity Type:Individual
Prefix:
First Name:KARLIN
Middle Name:DHARIANA
Last Name:WALCOTT
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4704
Mailing Address - Country:US
Mailing Address - Phone:845-343-7675
Mailing Address - Fax:845-343-2501
Practice Address - Street 1:305 NORTH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4704
Practice Address - Country:US
Practice Address - Phone:845-343-7675
Practice Address - Fax:845-343-2501
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006547101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty