Provider Demographics
NPI:1669567046
Name:PICKLER, CAROLYN IRENE (MA, LPCC)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:IRENE
Last Name:PICKLER
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 W MARKET ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9301
Mailing Address - Country:US
Mailing Address - Phone:330-666-5004
Mailing Address - Fax:330-666-5001
Practice Address - Street 1:3610 W MARKET ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9301
Practice Address - Country:US
Practice Address - Phone:330-666-5004
Practice Address - Fax:330-666-5001
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional