Healthcare Provider Details

I. General information

NPI: 1699944686
Provider Name (Legal Business Name): CARSON CHARLES WINN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 SANTA ANA BLVD
OAK VIEW CA
93022-9301
US

IV. Provider business mailing address

813 SANTA ANA BLVD
OAK VIEW CA
93022-9301
US

V. Phone/Fax

Practice location:
  • Phone: 310-691-6981
  • Fax: 310-691-6981
Mailing address:
  • Phone: 310-691-6981
  • Fax: 310-691-6981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 8735
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW60943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: