Provider Demographics
NPI:1528232717
Name:ALVORD, CAROLYNN MARIE (MA, RN, LLP, LPC, CC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYNN
Middle Name:MARIE
Last Name:ALVORD
Suffix:
Gender:F
Credentials:MA, RN, LLP, LPC, CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8155 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:MI
Mailing Address - Zip Code:49012-9261
Mailing Address - Country:US
Mailing Address - Phone:269-731-5486
Mailing Address - Fax:269-731-5486
Practice Address - Street 1:8799 GULL RD
Practice Address - Street 2:#6
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-9100
Practice Address - Country:US
Practice Address - Phone:269-207-7895
Practice Address - Fax:269-731-5486
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002275101Y00000X
MI6301009110103TC1900X
MI4704117831163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11833182OtherCAQH