Provider Demographics
NPI:1174816573
Name:BABB, CARMEN D (CADC)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:D
Last Name:BABB
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 EASTLAND DR
Mailing Address - Street 2:PO BOX 47
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7480
Mailing Address - Country:US
Mailing Address - Phone:208-732-0995
Mailing Address - Fax:208-732-0993
Practice Address - Street 1:493 EASTLAND DR
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-732-0995
Practice Address - Fax:208-732-0993
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1530013101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)