Provider Demographics
NPI:1578372462
Name:GUTSHALL, CAROLYN ANNE (LPC, PHD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANNE
Last Name:GUTSHALL
Suffix:
Gender:F
Credentials:LPC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:ISLE OF PALMS
Mailing Address - State:SC
Mailing Address - Zip Code:29451-2655
Mailing Address - Country:US
Mailing Address - Phone:843-810-4500
Mailing Address - Fax:
Practice Address - Street 1:1031 CHUCK DAWLEY BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4188
Practice Address - Country:US
Practice Address - Phone:843-410-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1341032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health