Provider Demographics
NPI:1114990199
Name:AYALA, CAROLYN (SW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515
Mailing Address - Country:US
Mailing Address - Phone:979-849-2447
Mailing Address - Fax:979-848-8337
Practice Address - Street 1:120 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515
Practice Address - Country:US
Practice Address - Phone:979-849-2447
Practice Address - Fax:979-848-8337
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22189104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker