Provider Demographics
NPI:1467763060
Name:PRINCE, CAROLYN (LPC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 E BROADWAY RD # L2043
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1773
Mailing Address - Country:US
Mailing Address - Phone:919-589-7009
Mailing Address - Fax:
Practice Address - Street 1:2134 E BROADWAY RD # L2043
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1773
Practice Address - Country:US
Practice Address - Phone:919-589-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLMHC001757101YM0800X
NJ37PC00365400101YP2500X
AZLPC15323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health