Provider Demographics
NPI:1700611720
Name:HELLHAKE, CAROLINA
Entity type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:
Last Name:HELLHAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:GONZALEZ LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3015
Mailing Address - Country:US
Mailing Address - Phone:908-764-0265
Mailing Address - Fax:
Practice Address - Street 1:410 ELM ST
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3015
Practice Address - Country:US
Practice Address - Phone:908-674-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01009200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health