Provider Demographics
NPI:1679861231
Name:GAMBLE, CAROLYN R (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:R
Last Name:GAMBLE
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 1:910 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2124
Mailing Address - Country:US
Mailing Address - Phone:803-536-4900
Mailing Address - Fax:803-536-4980
Practice Address - Street 1:910 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2124
Practice Address - Country:US
Practice Address - Phone:803-536-4900
Practice Address - Fax:803-536-4980
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional