# CARLY CRISTINE MCCORMACK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1700478625
- **Gender:** F
- **Credential:** LADC, LPCC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 305956 | MN | — |
| 101YM0800X | Mental Health Counselor | 3936 | MN | Yes |
| 101YP2500X | Professional Counselor | 3936 | MN | — |

## Other

- **Enumeration date:** 02/11/2021
- **Last updated:** 09/02/2026