Provider Demographics
NPI:1306008362
Name:ANTHONY-GARTLAN, CAROL J (MS, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:J
Last Name:ANTHONY-GARTLAN
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 UNION ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2477
Mailing Address - Country:US
Mailing Address - Phone:503-316-6770
Mailing Address - Fax:503-316-6801
Practice Address - Street 1:565 UNION ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2477
Practice Address - Country:US
Practice Address - Phone:503-316-6770
Practice Address - Fax:503-316-6801
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2842101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional