Provider Demographics
NPI:1942557533
Name:METHENY, CAROLYN SYLVESTER (MED,LPC,NCC,MAC,)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:SYLVESTER
Last Name:METHENY
Suffix:
Gender:F
Credentials:MED,LPC,NCC,MAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SPARKLEBERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:706-993-3175
Mailing Address - Fax:
Practice Address - Street 1:801 SPARKLEBERRY ROAD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-993-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA305074101YM0800X
GA006687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health