Provider Demographics
NPI:1962474205
Name:KOLB, CAROL A (MA, LMFT, LPC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:KOLB
Suffix:
Gender:F
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6845 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3363
Mailing Address - Country:US
Mailing Address - Phone:704-364-4333
Mailing Address - Fax:704-969-1175
Practice Address - Street 1:6845 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3363
Practice Address - Country:US
Practice Address - Phone:704-364-4333
Practice Address - Fax:704-969-1175
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2881101YP2500X
NC563106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist