Provider Demographics
NPI:1780717298
Name:KERR, CAROLYN GORMAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:GORMAN
Last Name:KERR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:GORMAN
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1512 WILLOW LAWN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3117
Mailing Address - Country:US
Mailing Address - Phone:804-285-5900
Mailing Address - Fax:804-285-9130
Practice Address - Street 1:1512 WILLOW LAWN DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3117
Practice Address - Country:US
Practice Address - Phone:804-285-5900
Practice Address - Fax:804-285-9130
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904004648101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical