Provider Demographics
NPI:1497316459
Name:ROTHE, CAROL P (LICSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:P
Last Name:ROTHE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 WILL HALSEY WAY
Mailing Address - Street 2:STE C
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2566
Mailing Address - Country:US
Mailing Address - Phone:256-325-1349
Mailing Address - Fax:
Practice Address - Street 1:708 WILL HALSEY WAY STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2566
Practice Address - Country:US
Practice Address - Phone:256-325-1349
Practice Address - Fax:256-325-1354
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1154C2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty