Provider Demographics
NPI:1902889389
Name:FRAZIER, CAROL A (LICSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 WILLIAMS ST BLDG 15
Mailing Address - Street 2:G-PRRTP VA TRANSITION CENTER
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4799
Mailing Address - Country:US
Mailing Address - Phone:505-722-3761
Mailing Address - Fax:505-722-0723
Practice Address - Street 1:513 WILLIAMS ST BLDG 15
Practice Address - Street 2:G-PRRTP VA TRANSITION CENTER
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4799
Practice Address - Country:US
Practice Address - Phone:505-722-3761
Practice Address - Fax:505-722-0723
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000055201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical