Provider Demographics
NPI:1205088440
Name:FAITH, CAROLE MICHELE (LPC, LMFT)
Entity type:Individual
Prefix:MISS
First Name:CAROLE
Middle Name:MICHELE
Last Name:FAITH
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 JACKSON SQUARE BLVD APT 6B
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2732
Mailing Address - Country:US
Mailing Address - Phone:318-798-6031
Mailing Address - Fax:318-678-6425
Practice Address - Street 1:8500 JACKSON SQUARE BLVD APT 6B
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2732
Practice Address - Country:US
Practice Address - Phone:318-798-6031
Practice Address - Fax:318-678-6425
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2707101YP2500X
LA658106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA658OtherLMFT
LA2707OtherLPC