Healthcare Provider Details

I. General information

NPI: 1740329663
Provider Name (Legal Business Name): MATTHEW ALLEN CARLSON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CARLTON ST COUNSELING AND PSYCHIATRIC SERVICES
ATHENS GA
30602-1503
US

IV. Provider business mailing address

55 CARLTON ST COUNSELING AND PSYCHIATRIC SERVICES
ATHENS GA
30602-1503
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-2273
  • Fax: 706-542-8661
Mailing address:
  • Phone: 610-266-0610
  • Fax: 610-266-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003478
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: