Provider Demographics
NPI:1851964464
Name:MIKULKA, CAROLYNN JEANNE (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:CAROLYNN
Middle Name:JEANNE
Last Name:MIKULKA
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9025 OVERLOOK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2710
Mailing Address - Country:US
Mailing Address - Phone:407-718-8964
Mailing Address - Fax:
Practice Address - Street 1:9025 OVERLOOK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2710
Practice Address - Country:US
Practice Address - Phone:615-212-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5602101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional