Provider Demographics
NPI:1184210221
Name:CARLINE, EMMA MARTIN (LPC, LPC-S)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:MARTIN
Last Name:CARLINE
Suffix:
Gender:F
Credentials:LPC, LPC-S
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:ELIZABETH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:204 SANDY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5351
Mailing Address - Country:US
Mailing Address - Phone:337-257-4714
Mailing Address - Fax:
Practice Address - Street 1:204 SANDY BROOK LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5351
Practice Address - Country:US
Practice Address - Phone:337-257-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional