Provider Demographics
NPI:1336204080
Name:CARLSON, CARL M (LCSW)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:M
Last Name:CARLSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HIGHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1415
Mailing Address - Country:US
Mailing Address - Phone:530-949-5313
Mailing Address - Fax:530-892-0488
Practice Address - Street 1:9 HIGHLAND CIR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-949-5313
Practice Address - Fax:530-892-0488
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 195291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS195290OtherBLUE SHIELD