Provider Demographics
NPI:1841447505
Name:KERBY, CARA JEAN (LPCC, LAADC)
Entity type:Individual
Prefix:MS
First Name:CARA
Middle Name:JEAN
Last Name:KERBY
Suffix:
Gender:F
Credentials:LPCC, LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SCENIC RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1556
Mailing Address - Country:US
Mailing Address - Phone:918-718-9004
Mailing Address - Fax:
Practice Address - Street 1:412 RED HILL AVE STE 5
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2468
Practice Address - Country:US
Practice Address - Phone:415-295-6438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARALR11101214101YA0400X
CA8071101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional