Provider Demographics
NPI:1093960254
Name:POULSON, CARRIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:POULSON
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 1:9740 NUTBY LN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-4510
Mailing Address - Country:US
Mailing Address - Phone:858-216-5633
Mailing Address - Fax:
Practice Address - Street 1:9740 NUTBY LN
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-4510
Practice Address - Country:US
Practice Address - Phone:582-165-6338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA997421041C0700X
CAASW72568101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health