Provider Demographics
NPI:1407684806
Name:RAWLES, CARSON MCBRIDE JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARSON
Middle Name:MCBRIDE
Last Name:RAWLES
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1771 PINE SHADOWS WAY APT 2811
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-6573
Mailing Address - Country:US
Mailing Address - Phone:571-241-9847
Mailing Address - Fax:
Practice Address - Street 1:1771 PINE SHADOWS WAY APT 2811
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6573
Practice Address - Country:US
Practice Address - Phone:571-241-9847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704008636103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical