Provider Demographics
NPI:1023511359
Name:BARBER, CAROLYN ELAINE (OTHER)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ELAINE
Last Name:BARBER
Suffix:
Gender:F
Credentials:OTHER
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:ELAINE
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTHER
Mailing Address - Street 1:4102 INNIS DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-4749
Mailing Address - Country:US
Mailing Address - Phone:318-623-7643
Mailing Address - Fax:
Practice Address - Street 1:1403 METRO DR STE C1
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3446
Practice Address - Country:US
Practice Address - Phone:318-625-7467
Practice Address - Fax:318-625-7420
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health