Provider Demographics
NPI:1184852824
Name:CARLSON, KYM LISABETH (MA)
Entity Type:Individual
Prefix:MRS
First Name:KYM
Middle Name:LISABETH
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36250 DEQUINDRE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-7143
Mailing Address - Country:US
Mailing Address - Phone:586-795-0569
Mailing Address - Fax:
Practice Address - Street 1:36250 DEQUINDRE RD
Practice Address - Street 2:STE 310
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-7143
Practice Address - Country:US
Practice Address - Phone:586-795-0569
Practice Address - Fax:586-795-2761
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor