Provider Demographics
NPI:1003490251
Name:CARLSON, CAROLINE (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W MARTIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-2991
Mailing Address - Country:US
Mailing Address - Phone:855-641-1379
Mailing Address - Fax:
Practice Address - Street 1:16 W MARTIN ST STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-2991
Practice Address - Country:US
Practice Address - Phone:855-641-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0146331041C0700X
FLSW175321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical