Provider Demographics
NPI:1164432019
Name:TREADWELL, CAROL A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:TREADWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:TREADWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 2523
Mailing Address - Street 2:TIME OUT
Mailing Address - City:BIG BEAR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92314-2523
Mailing Address - Country:US
Mailing Address - Phone:909-878-4388
Mailing Address - Fax:909-878-4388
Practice Address - Street 1:848 PANAMINT MOUNTAIN DRIVE
Practice Address - Street 2:
Practice Address - City:BIG BEAR CITY
Practice Address - State:CA
Practice Address - Zip Code:92314-2523
Practice Address - Country:US
Practice Address - Phone:909-878-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS185951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical