Provider Demographics
NPI:1255148375
Name:FUTCHKO, CAROLYN (LPC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:FUTCHKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2895 GRADYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-1026
Mailing Address - Country:US
Mailing Address - Phone:610-246-1847
Mailing Address - Fax:
Practice Address - Street 1:967 SWEDESFORD RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355
Practice Address - Country:US
Practice Address - Phone:610-246-1847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional