Provider Demographics
NPI:1821004284
Name:DIFABIO, CAROL A (LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:DIFABIO
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 1:11815 NORTHFALL LN
Mailing Address - Street 2:STE. 1006
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7973
Mailing Address - Country:US
Mailing Address - Phone:770-240-8363
Mailing Address - Fax:770-442-7774
Practice Address - Street 1:11815 NORTHFALL LN
Practice Address - Street 2:STE. 1006
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-7973
Practice Address - Country:US
Practice Address - Phone:770-240-8363
Practice Address - Fax:770-442-7774
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional