Provider Demographics
NPI:1790128379
Name:ROBINSON HAFTMANN, CARLY J (LPC)
Entity Type:Individual
Prefix:MISS
First Name:CARLY
Middle Name:J
Last Name:ROBINSON HAFTMANN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3786 GRAY MARKET DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-3111
Mailing Address - Country:US
Mailing Address - Phone:337-377-3626
Mailing Address - Fax:
Practice Address - Street 1:402 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:LA
Practice Address - Zip Code:70655-3519
Practice Address - Country:US
Practice Address - Phone:337-639-3001
Practice Address - Fax:337-639-3008
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA 4166101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional