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General NPI Number Information
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NPI Number | 1336204080
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Entity Type | Individual
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Provider Name | CARL M. CARLSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 9 HIGHLAND CIR
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City | CHICO
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State | CA
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Zip | 95926
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Country | US
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Telephone | 530-949-5313
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Fax | 530-892-0488
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Provider Business Mailing Address
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Address Line | 9 HIGHLAND CIR
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City | CHICO
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State | CA
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Zip | 95926-1415
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Country | US
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Telephone | 530-949-5313
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Fax | 530-892-0488
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW 19529
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License Number State | CA
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