Healthcare Provider Details

I. General information

NPI: 1811812183
Provider Name (Legal Business Name): CARSON PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5026 TRANQUIL TRL
TOANO VA
23168-9142
US

IV. Provider business mailing address

5026 TRANQUIL TRL
TOANO VA
23168-9142
US

V. Phone/Fax

Practice location:
  • Phone: 804-840-6066
  • Fax:
Mailing address:
  • Phone: 804-840-6066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: CAMILLE I CARSON
Title or Position: CLINICAL DIRECTOR
Credential: PH.D.
Phone: 804-840-6066