Provider Demographics
NPI:1205919560
Name:HERTZ, CAROLE M (EDD)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:M
Last Name:HERTZ
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 EAST LEE STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:US
Mailing Address - Phone:540-347-0613
Mailing Address - Fax:540-347-0768
Practice Address - Street 1:54 EAST LEE STREET
Practice Address - Street 2:FAUQUIER COUNSELING CENTER
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186
Practice Address - Country:US
Practice Address - Phone:540-347-0613
Practice Address - Fax:540-347-0768
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional