Provider Demographics
NPI:1679659981
Name:PENICK, CAROL L (LPC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:PENICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5763
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27113-5763
Mailing Address - Country:US
Mailing Address - Phone:336-310-3348
Mailing Address - Fax:
Practice Address - Street 1:942 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2582
Practice Address - Country:US
Practice Address - Phone:336-607-7555
Practice Address - Fax:336-607-7555
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC #3028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional