Provider Demographics
NPI:1699855585
Name:BROCKMANN, CAROLYN THOMPSON (MED, LPC, NC-LCAS,)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:THOMPSON
Last Name:BROCKMANN
Suffix:
Gender:F
Credentials:MED, LPC, NC-LCAS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 SETLIFF DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8011
Mailing Address - Country:US
Mailing Address - Phone:336-454-5502
Mailing Address - Fax:
Practice Address - Street 1:2240 SETLIFF DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8011
Practice Address - Country:US
Practice Address - Phone:336-454-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33101YA0400X
NC595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8103026Medicaid