Provider Demographics
NPI:1063732253
Name:WHITSON, CARLA-JO (MSW)
Entity type:Individual
Prefix:MS
First Name:CARLA-JO
Middle Name:
Last Name:WHITSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:CARLA-JO
Other - Middle Name:
Other - Last Name:WHITSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2409 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3228
Mailing Address - Country:US
Mailing Address - Phone:360-567-4590
Mailing Address - Fax:360-213-1816
Practice Address - Street 1:2409 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3228
Practice Address - Country:US
Practice Address - Phone:360-567-4590
Practice Address - Fax:360-213-1816
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker