Provider Demographics
NPI:1295865939
Name:CARLTON, KATINA MARIE (BA)
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:MARIE
Last Name:CARLTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RURAL ROUTE 1 BOX 131 C
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OKLAHOMA
Mailing Address - Zip Code:74426
Mailing Address - Country:UM
Mailing Address - Phone:918-452-3133
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 131C
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-9223
Practice Address - Country:US
Practice Address - Phone:918-452-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health