Healthcare Provider Details

I. General information

NPI: 1629056858
Provider Name (Legal Business Name): CAROL ORTON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 E VALLEY ST
WILLITS CA
95490-3623
US

IV. Provider business mailing address

PO BOX 1885
WILLITS CA
95490-1885
US

V. Phone/Fax

Practice location:
  • Phone: 707-459-3124
  • Fax:
Mailing address:
  • Phone: 707-459-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 17331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: