Provider Demographics
NPI:1093354623
Name:HULSE, CAROLYN ELIZABETH (LMHC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:HULSE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24700 US HWY 331 SOUTH
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-8123
Mailing Address - Country:US
Mailing Address - Phone:850-296-2607
Mailing Address - Fax:
Practice Address - Street 1:24700 HWY 331 SOUTH
Practice Address - Street 2:SUITE 104
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-3245
Practice Address - Country:US
Practice Address - Phone:850-296-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17614101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health