Healthcare Provider Details

I. General information

NPI: 1124417696
Provider Name (Legal Business Name): JANINE CARLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 HARTNELL AVE
REDDING CA
96002-2113
US

IV. Provider business mailing address

1147 HARTNELL AVE
REDDING CA
96002-2113
US

V. Phone/Fax

Practice location:
  • Phone: 530-222-7213
  • Fax:
Mailing address:
  • Phone: 530-222-7213
  • Fax: 530-222-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60255508
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: