| Doctor Name: | MS. CARLY GOTTEHRER |
| NPI Number: | 1104123496 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 002236 |
| Business Practice Address: | 433 Valley St Willimantic, CT - 062261901 |
| Business Phone Number: | 8604237220 |
| Business Fax Number: | 8604237366 |
| Mailing Address: | 433 Valley St, WILLIMANTIC |
| State: | CT |
| Postal Code: | 062261901 |
| Phone Number: | 8604237220 |
| Fax Number: | 8604237366 |
| NPI Enumeration Date: | 02/22/2011 |
| NPI Last Update Date: | 06/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 002236 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |