Provider Demographics
NPI:1275825119
Name:PRAVATTA, CAROLYNN (MS, LADC)
Entity Type:Individual
Prefix:
First Name:CAROLYNN
Middle Name:
Last Name:PRAVATTA
Suffix:
Gender:F
Credentials:MS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 S MARYLAND PKWY STE 211
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7520
Mailing Address - Country:US
Mailing Address - Phone:702-384-2960
Mailing Address - Fax:702-384-2963
Practice Address - Street 1:3909 S MARYLAND PKWY STE 211
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7520
Practice Address - Country:US
Practice Address - Phone:702-384-2960
Practice Address - Fax:702-384-2963
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1175101YA0400X
NV340S101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)