Provider Demographics
NPI:1679012108
Name:STANSFIELD, CAROL (LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:STANSFIELD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:SERVADIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 W AVON RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2209
Mailing Address - Country:US
Mailing Address - Phone:860-404-0755
Mailing Address - Fax:
Practice Address - Street 1:380 W AVON RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2209
Practice Address - Country:US
Practice Address - Phone:860-404-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional