Provider Demographics
NPI:1699988469
Name:CARLSON, CHRISTA (LVN)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 HAMER DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870
Mailing Address - Country:US
Mailing Address - Phone:714-783-8795
Mailing Address - Fax:
Practice Address - Street 1:1707 HAMER DRIVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870
Practice Address - Country:US
Practice Address - Phone:714-783-8795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN222906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN222906OtherLVN LICENSE