Provider Demographics
NPI:1578791554
Name:SEDGWICK, CARLY RENEE (MS, EDS, LPCC)
Entity Type:Individual
Prefix:MS
First Name:CARLY
Middle Name:RENEE
Last Name:SEDGWICK
Suffix:
Gender:F
Credentials:MS, EDS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 BOBCAT BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1335
Mailing Address - Country:US
Mailing Address - Phone:505-850-3696
Mailing Address - Fax:
Practice Address - Street 1:937 BOBCAT BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-1335
Practice Address - Country:US
Practice Address - Phone:505-850-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO0014090101YM0800X
NM0156261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health