Provider Demographics
NPI:1275743379
Name:MCFALL, CAROL JAYNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JAYNE
Last Name:MCFALL
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 1:2214 N ATHERTON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1544
Mailing Address - Country:US
Mailing Address - Phone:814-237-0567
Mailing Address - Fax:814-237-0569
Practice Address - Street 1:2214 N ATHERTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-1544
Practice Address - Country:US
Practice Address - Phone:814-237-0567
Practice Address - Fax:814-237-0569
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024450420001Medicaid