Basic Information
| Provider Information | |||||||||
| NPI: | 1790128379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON HAFTMANN | ||||||||
| FirstName: | CARLY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3786 GRAY MARKET DR | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706053111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373773626 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 402 INDUSTRIAL DR | ||||||||
| Address2: | |||||||||
| City: | OBERLIN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706553519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3376393001 | ||||||||
| FaxNumber: | 3376393008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2013 | ||||||||
| LastUpdateDate: | 10/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LA 4166 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.