Provider Demographics
NPI:1114002490
Name:ROYALL, CARMEN LEE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:LEE
Last Name:ROYALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3018
Mailing Address - Country:US
Mailing Address - Phone:610-478-7115
Mailing Address - Fax:610-478-7118
Practice Address - Street 1:947 PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3018
Practice Address - Country:US
Practice Address - Phone:610-478-7115
Practice Address - Fax:610-478-7118
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional