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General NPI Number Information
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NPI Number | 1710102595
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Entity Type | Individual
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Provider Name | CAROL VICTOR CARLSON DOCTORATE - PHD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 4199 CAMPUS DR STE 550
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City | IRVINE
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State | CA
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Zip | 92612-4694
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Country | US
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Telephone | 510-444-1110
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Fax | 949-885-8885
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Provider Business Mailing Address
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Address Line | 405 ROCKEFELLER UNIT 906
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City | IRVINE
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State | CA
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Zip | 92612-7192
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Country | US
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Telephone | 510-444-1110
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Fax | 949-885-8885
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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 | PSY14518
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY14518
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License Number State | CA
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