Provider Demographics
NPI:1528413440
Name:DISHMAN, CAROLYN (LAC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:DISHMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:DISHMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC 636
Mailing Address - Street 1:1647 SAVANNE RD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8907
Mailing Address - Country:US
Mailing Address - Phone:985-855-7769
Mailing Address - Fax:985-876-5551
Practice Address - Street 1:5 SECURITY BLVD STE F
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2780
Practice Address - Country:US
Practice Address - Phone:985-709-9147
Practice Address - Fax:985-876-5551
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALAC 636101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)