Provider Demographics
NPI:1811056229
Name:VAN HOOSE, CARLA MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:MARIE
Last Name:VAN HOOSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:MARIE
Other - Last Name:ENOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:501 DARBY CREEK RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1604
Mailing Address - Country:US
Mailing Address - Phone:859-263-2377
Mailing Address - Fax:859-263-7410
Practice Address - Street 1:501 DARBY CREEK RD
Practice Address - Street 2:SUITE 3
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1604
Practice Address - Country:US
Practice Address - Phone:859-263-2377
Practice Address - Fax:859-263-7410
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04543101YA0400X
KYLCSW- 3821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical