Individual
DR. CAROL LOUCKS NAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST
Contact information
Practice address
770 W GRANADA BLVD, SUITE 206, ORMOND BEACH, FL 32174-5188
(386) 673-8494
(386) 672-8381
Mailing address
770 W GRANADA BLVD, SUITE 206, ORMOND BEACH, FL 32174-5188
(386) 673-8494
(386) 672-8381
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY4973
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT1355
STATE LICENSE
FL
01
—
PY4973
STATE LICENSE
FL
Enumeration date
08/24/2006
Last updated
07/09/2007
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