Provider Demographics
NPI:1336256627
Name:NAK, CAROL LOUCKS (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LOUCKS
Last Name:NAK
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:770 W GRANADA BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5188
Mailing Address - Country:US
Mailing Address - Phone:386-673-8494
Mailing Address - Fax:386-672-8381
Practice Address - Street 1:770 W GRANADA BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5188
Practice Address - Country:US
Practice Address - Phone:386-673-8494
Practice Address - Fax:386-672-8381
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPY4973103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT1355OtherSTATE LICENSE
FLPY4973OtherSTATE LICENSE
FLPY4973OtherSTATE LICENSE