MEDICARE: KRISTINA CARLSON LMHC, LCDP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6070	CT
2	101YM0800X	Mental Health Counselor	MHC01113	RI
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDP00715	RI
4	101YM0800X	Mental Health Counselor	6070	CT

General Provider Information

NPI Number	:	1265969463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA CARLSON LMHC, LCDP

Provider Business Mailing Address
First Line	:	1239 HILL FARM RD
Second Line	:
City	:	COVENTRY
State	:	RI
Zip	:	02816-6936
Country	:	US
Telephone Number	:	401-575-8559
Fax Number	:

Provider Business Practice Location Address
First Line	:	2845 POST RD STE 307
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-3145
Country	:	US
Telephone Number	:	401-528-0193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2017
Last Update Date	:	03/13/2026

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