Provider Demographics
NPI:1053069989
Name:CARNELIAN LLC
Entity Type:Organization
Organization Name:CARNELIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDWEHR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW, REAT, CST
Authorized Official - Phone:314-324-3835
Mailing Address - Street 1:7827 TOWN SQUARE AVE # 104-1092
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7197
Mailing Address - Country:US
Mailing Address - Phone:314-200-5113
Mailing Address - Fax:314-552-7539
Practice Address - Street 1:7827 TOWN SQUARE AVE # 104-1092
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7197
Practice Address - Country:US
Practice Address - Phone:314-200-5113
Practice Address - Fax:314-552-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty