Provider Demographics
NPI:1053342659
Name:TJOLAND, CAROLYN (LPCC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:TJOLAND
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23302
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-3302
Mailing Address - Country:US
Mailing Address - Phone:505-577-1919
Mailing Address - Fax:
Practice Address - Street 1:901 W ALAMEDA ST
Practice Address - Street 2:SUITE 25
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1681
Practice Address - Country:US
Practice Address - Phone:505-955-9436
Practice Address - Fax:505-955-9437
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPCC 3086101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM57335273Medicaid