Provider Demographics
NPI:1134648108
Name:GILSON, CAROL D (LCSW, MSSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:D
Last Name:GILSON
Suffix:
Gender:F
Credentials:LCSW, MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 RIBBECKE AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78721-1422
Mailing Address - Country:US
Mailing Address - Phone:512-925-1473
Mailing Address - Fax:
Practice Address - Street 1:111 E 17TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1403
Practice Address - Country:US
Practice Address - Phone:512-920-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX598691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty