Provider Demographics
NPI:1013391556
Name:CARLOTTA D. WINN
Entity Type:Organization
Organization Name:CARLOTTA D. WINN
Other - Org Name:CARLOTTA D. WINN
Other - Org Type:Other Name
Authorized Official - Title/Position:QUALIFIED BEHAVIORAL AIDE
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLOTTA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-771-7124
Mailing Address - Street 1:5800 W CHARLESTON BLVD
Mailing Address - Street 2:# 1073
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1295
Mailing Address - Country:US
Mailing Address - Phone:702-771-7124
Mailing Address - Fax:
Practice Address - Street 1:5800 W CHARLESTON BLVD
Practice Address - Street 2:# 1073
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1292
Practice Address - Country:US
Practice Address - Phone:702-771-7124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1601159921OtherDMV