Provider Demographics
NPI:1770146284
Name:KOON, CARLA ANNE (LLPC)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:ANNE
Last Name:KOON
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10223 HEATHER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438-9063
Mailing Address - Country:US
Mailing Address - Phone:810-513-9006
Mailing Address - Fax:
Practice Address - Street 1:8308 OFFICE PARK DR STE 3
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2075
Practice Address - Country:US
Practice Address - Phone:810-584-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802080026104100000X
MI6451007253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker