Provider Demographics
NPI:1043014913
Name:MASSEY, CAROL (MA, APCC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MASSEY
Suffix:
Gender:
Credentials:MA, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-4549
Mailing Address - Country:US
Mailing Address - Phone:817-201-2028
Mailing Address - Fax:
Practice Address - Street 1:411 N INDIAN HILL BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4614
Practice Address - Country:US
Practice Address - Phone:626-214-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19054101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor