Provider Demographics
NPI:1356637904
Name:PATTERSON, CAROL JEAN (LPCC, LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LPCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SAINT MICHAELS DR
Mailing Address - Street 2:STUDENT HEALTH CENTER
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7615
Mailing Address - Country:US
Mailing Address - Phone:505-473-6362
Mailing Address - Fax:
Practice Address - Street 1:1600 SAINT MICHAELS DR
Practice Address - Street 2:STUDENT HEALTH CENTER
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7615
Practice Address - Country:US
Practice Address - Phone:505-473-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60160858101YM0800X
NMLPCC0176101101YP2500X
COLPC0012189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health