Provider Demographics
NPI:1295916823
Name:ANGLIN, CAROLYN A (LMHC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:ANGLIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:A
Other - Last Name:SHELLIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:4404 S FLORIDA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2183
Mailing Address - Country:US
Mailing Address - Phone:863-709-8110
Mailing Address - Fax:863-709-8118
Practice Address - Street 1:4404 S FLORIDA AVE STE 3
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2183
Practice Address - Country:US
Practice Address - Phone:863-709-8110
Practice Address - Fax:863-709-8118
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7454101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health