Provider Demographics
NPI:1295395036
Name:GERALD, CARISA MICHELLE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:CARISA
Middle Name:MICHELLE
Last Name:GERALD
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:PO BOX 7544
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-7544
Mailing Address - Country:US
Mailing Address - Phone:843-773-6186
Mailing Address - Fax:843-989-0175
Practice Address - Street 1:181 E EVANS ST STE C5
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-5502
Practice Address - Country:US
Practice Address - Phone:843-731-9016
Practice Address - Fax:843-989-0175
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7130101YM0800X
SC7838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health