Provider Demographics
NPI:1164731816
Name:CARSON, BETTY A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:A
Last Name:CARSON
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 1:680 W LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1622
Mailing Address - Country:US
Mailing Address - Phone:302-653-8642
Mailing Address - Fax:
Practice Address - Street 1:5407 KILLENS POND RD
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:DE
Practice Address - Zip Code:19943-1901
Practice Address - Country:US
Practice Address - Phone:302-284-3800
Practice Address - Fax:302-284-3892
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0001025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health