Provider Demographics
NPI:1801271614
Name:CAROLAN, VINCENT (MA, CAADC, LPC)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:CAROLAN
Suffix:
Gender:M
Credentials:MA, CAADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N ABINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS GREEN
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2505
Mailing Address - Country:US
Mailing Address - Phone:570-586-3234
Mailing Address - Fax:
Practice Address - Street 1:108 N ABINGTON RD
Practice Address - Street 2:
Practice Address - City:CLARKS GREEN
Practice Address - State:PA
Practice Address - Zip Code:18411-2505
Practice Address - Country:US
Practice Address - Phone:570-586-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC002452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)