Provider Demographics
NPI:1386298628
Name:CARLSON, TABER (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:TABER
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0011
Mailing Address - Country:US
Mailing Address - Phone:605-641-7328
Mailing Address - Fax:
Practice Address - Street 1:1010 CRABAPPLE CIR
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4123
Practice Address - Country:US
Practice Address - Phone:605-641-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC04543101YP2500X
ALC3340A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor