Provider Demographics
NPI:1205962669
Name:MANSFIELD, CAROL LOUINE (RI)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LOUINE
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:RI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 LINCOLN AVE
Mailing Address - Street 2:PO BOX 1164
Mailing Address - City:CALISTOGA
Mailing Address - State:CA
Mailing Address - Zip Code:94515-1115
Mailing Address - Country:US
Mailing Address - Phone:707-942-1179
Mailing Address - Fax:
Practice Address - Street 1:14709 LAKESHORE DRIVE
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422
Practice Address - Country:US
Practice Address - Phone:707-995-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-M0701032214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)