Individual
CAROLYN S SOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
6558 MAIN STREET, MORGAN BLDG., STE 1 OFFICE 3 AND 3A, GLOUCESTER, VA 23061-4162
(804) 699-3238
(804) 699-3731
Mailing address
PO BOX 549, GLOUCESTER, VA 23061-0549
(804) 699-3238
(804) 699-3731
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701001882
VA
106H00000X
Marriage & Family Therapist
0717000854
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000000
—
VA
Enumeration date
04/07/2006
Last updated
04/27/2021
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