Provider Demographics
NPI:1215022751
Name:OVERTON, CAROL GROVES (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:GROVES
Last Name:OVERTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 SWAYZE AVE.
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1426
Mailing Address - Country:US
Mailing Address - Phone:215-321-0672
Mailing Address - Fax:215-321-1293
Practice Address - Street 1:978 SWAYZE AVE.
Practice Address - Street 2:
Practice Address - City:WASHINGTON CROSSING
Practice Address - State:PA
Practice Address - Zip Code:18977-1426
Practice Address - Country:US
Practice Address - Phone:215-321-0672
Practice Address - Fax:215-321-1293
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005375-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical