Healthcare Provider Details

I. General information

NPI: 1821305152
Provider Name (Legal Business Name): CARRIE CARLSON HLADKY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INWOOD DRIVE
COVINGTON LA
70433
US

IV. Provider business mailing address

1519 ARISTOCRAT COURT
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 985-373-3568
  • Fax: 985-662-5165
Mailing address:
  • Phone: 985-373-3568
  • Fax: 985-662-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4260
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW:4260
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: