Provider Demographics
NPI:1457845018
Name:HORNUNG, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:HORNUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:LEAVITT, SULLIVAN, ALLRED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED
Mailing Address - Street 1:PO BOX 872370
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-2370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5730 E PILGRIM CT STE A
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7824
Practice Address - Country:US
Practice Address - Phone:907-357-6513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1225268832OtherOLIVE TREE COUNSELING, INC