Provider Demographics
NPI:1477541928
Name:ERICKSON, CAROLYN (LPC C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LPC C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 TRINITY DR
Mailing Address - Street 2:STE C
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2226
Mailing Address - Country:US
Mailing Address - Phone:505-662-1419
Mailing Address - Fax:505-661-0055
Practice Address - Street 1:3250 TRINITY DR
Practice Address - Street 2:STE C
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2226
Practice Address - Country:US
Practice Address - Phone:505-662-1419
Practice Address - Fax:505-661-0055
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0073101101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health