Provider Demographics
NPI:1689110249
Name:LOFSTROM, CARRIE ELLEN (LPC, CPCS)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ELLEN
Last Name:LOFSTROM
Suffix:
Gender:F
Credentials:LPC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 GLOUCESTER ST.
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520
Mailing Address - Country:US
Mailing Address - Phone:678-595-4723
Mailing Address - Fax:912-289-9389
Practice Address - Street 1:513 GLOUCESTER ST.
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520
Practice Address - Country:US
Practice Address - Phone:912-289-2497
Practice Address - Fax:912-289-9389
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional