Provider Demographics
NPI:1609317338
Name:EALOM, CARMELLA (LLPC)
Entity Type:Individual
Prefix:MS
First Name:CARMELLA
Middle Name:
Last Name:EALOM
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON HTS
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1508
Mailing Address - Country:US
Mailing Address - Phone:231-736-6270
Mailing Address - Fax:
Practice Address - Street 1:1040 NEWELL
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349
Practice Address - Country:US
Practice Address - Phone:231-689-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010956101YP2500X
MI6451010956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional