Provider Demographics
NPI:1932618360
Name:DEMARRA, CAROLYN ALICIA (MS, LPC, CBIS)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ALICIA
Last Name:DEMARRA
Suffix:
Gender:F
Credentials:MS, LPC, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1817 OLDE HOMESTEAD LN STE 201
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6751
Practice Address - Country:US
Practice Address - Phone:717-394-3466
Practice Address - Fax:717-394-1252
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA009566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty