Healthcare Provider Details

I. General information

NPI: 1235061607
Provider Name (Legal Business Name): CARLSON CONSULTING CC PSYCHOLOGICAL CORPORATION, DBA CARLSON CONSULTING CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19200 VON KARMAN AVE STE 600
IRVINE CA
92612-8516
US

IV. Provider business mailing address

405 ROCKEFELLER APT 906
IRVINE CA
92612-7192
US

V. Phone/Fax

Practice location:
  • Phone: 510-444-1110
  • Fax: 949-885-8885
Mailing address:
  • Phone: 510-444-1110
  • Fax: 949-885-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROL VICTOR CARLSON
Title or Position: CLINICAL & CONSULTING PSYCHOLOGIST
Credential: PH.D.
Phone: 510-444-1110