Provider Demographics
NPI:1639722614
Name:CAROLYN EWALT, LPC, LLC
Entity Type:Organization
Organization Name:CAROLYN EWALT, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:EWALT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:724-799-3393
Mailing Address - Street 1:8150 PERRY HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5232
Mailing Address - Country:US
Mailing Address - Phone:724-799-3393
Mailing Address - Fax:
Practice Address - Street 1:8150 PERRY HWY STE 104
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5232
Practice Address - Country:US
Practice Address - Phone:724-799-3393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty