Provider Demographics
NPI:1295557668
Name:MAYER, CAROL BAKKE (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:BAKKE
Last Name:MAYER
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 1:8 HEMLOCK CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2309
Mailing Address - Country:US
Mailing Address - Phone:540-623-0903
Mailing Address - Fax:
Practice Address - Street 1:8 HEMLOCK CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2309
Practice Address - Country:US
Practice Address - Phone:540-623-0903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000720106H00000X
VA0701001847101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist