Provider Demographics
NPI:1659496354
Name:THOMASSON, CAROLINA (LPC, CAC III, NCC)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:THOMASSON
Suffix:
Gender:F
Credentials:LPC, CAC III, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 EAST AGATE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446
Mailing Address - Country:US
Mailing Address - Phone:970-402-0203
Mailing Address - Fax:970-887-2293
Practice Address - Street 1:191 EAST AGATE AVE.
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446
Practice Address - Country:US
Practice Address - Phone:970-402-0203
Practice Address - Fax:970-887-2293
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6580101YA0400X
CO5437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional