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General NPI Number Information
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NPI Number | 1346525169
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Entity Type | Individual
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Provider Name | LAURI WRENN CARLSON PHD, LCP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 887B RIO EAST CT
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-8004
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Country | US
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Telephone | 434-220-4686
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Fax |
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Provider Business Mailing Address
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Address Line | 151 BLUE MOUNTAIN LN
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City | SCOTTSVILLE
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State | VA
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Zip | 24590-4408
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Country | US
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Telephone | 434-466-3679
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810004485
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License Number State | VA
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