Provider Demographics
NPI:1629785464
Name:FUENTES, CAROLINA (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19627 INTERSTATE 45 N STE 210
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-6028
Mailing Address - Country:US
Mailing Address - Phone:281-857-4537
Mailing Address - Fax:
Practice Address - Street 1:19627 INTERSTATE 45 N STE 210
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-6028
Practice Address - Country:US
Practice Address - Phone:281-857-4537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX581691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical