Provider Demographics
NPI:1518181163
Name:CARSON, CHRISTINA (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 SAINT ALBANS BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2826
Mailing Address - Country:US
Mailing Address - Phone:512-689-7677
Mailing Address - Fax:512-440-0145
Practice Address - Street 1:1708 ST. ALBANS BLVD.
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-2826
Practice Address - Country:US
Practice Address - Phone:512-689-7677
Practice Address - Fax:512-440-0145
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028687402Medicaid