Provider Demographics
NPI:1912251075
Name:HOIDAL, CAROLYN LOUISE
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:LOUISE
Last Name:HOIDAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S WATER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4965
Mailing Address - Country:US
Mailing Address - Phone:252-338-0098
Mailing Address - Fax:252-335-1493
Practice Address - Street 1:400 S WATER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4965
Practice Address - Country:US
Practice Address - Phone:252-338-0098
Practice Address - Fax:252-335-1493
Is Sole Proprietor?:No
Enumeration Date:2012-10-28
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional