Provider Demographics
NPI:1407975683
Name:CARLSON HEALTH PROMOTION
Entity Type:Organization
Organization Name:CARLSON HEALTH PROMOTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-483-8054
Mailing Address - Street 1:8833 PERIMETER PARK BLVD STE 1202
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1128
Mailing Address - Country:US
Mailing Address - Phone:904-641-6788
Mailing Address - Fax:
Practice Address - Street 1:8833 PERIMETER PARK BLVD STE 1202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1128
Practice Address - Country:US
Practice Address - Phone:904-641-6788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6537103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4949Medicare ID - Type Unspecified