Provider Demographics
NPI:1134660871
Name:LARA-LERMA, CAROLINA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:LARA-LERMA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18915 W SHAW BUTTE DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-3278
Mailing Address - Country:US
Mailing Address - Phone:915-667-8227
Mailing Address - Fax:
Practice Address - Street 1:4577 W PECOS RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-9002
Practice Address - Country:US
Practice Address - Phone:520-610-5556
Practice Address - Fax:520-550-6033
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0185871101YM0800X
AZLPC-21088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health