Provider Demographics
NPI:1225098809
Name:BULWINKLE, CAROL (LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BULWINKLE
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 1:9291 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9126
Mailing Address - Country:US
Mailing Address - Phone:843-797-3664
Mailing Address - Fax:843-820-1007
Practice Address - Street 1:9291 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9126
Practice Address - Country:US
Practice Address - Phone:843-797-3664
Practice Address - Fax:843-820-1007
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC 1903101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health