Provider Demographics
NPI:1851137301
Name:BLUE HAIRED SOCIAL WORKER
Entity type:Organization
Organization Name:BLUE HAIRED SOCIAL WORKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:469-264-0989
Mailing Address - Street 1:7128 WOODLAND TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-3764
Mailing Address - Country:US
Mailing Address - Phone:469-903-6800
Mailing Address - Fax:
Practice Address - Street 1:7128 WOODLAND TERRACE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-3764
Practice Address - Country:US
Practice Address - Phone:469-903-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty